Healthcare Provider Details

I. General information

NPI: 1629690755
Provider Name (Legal Business Name): YANEKSI CHAVEZ MON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10017 SAVANNAH BLUFF LN
ORLANDO FL
32829-8230
US

IV. Provider business mailing address

10017 SAVANNAH BLUFF LN
ORLANDO FL
32829-8230
US

V. Phone/Fax

Practice location:
  • Phone: 786-300-7517
  • Fax:
Mailing address:
  • Phone: 786-300-7517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-115309
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: