Healthcare Provider Details

I. General information

NPI: 1245762582
Provider Name (Legal Business Name): NELY CALDERON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 NW FEDERAL HWY STE 173
STUART FL
34994-1019
US

IV. Provider business mailing address

1821 FOREST AVE APT 1
WEST PALM BEACH FL
33406-6430
US

V. Phone/Fax

Practice location:
  • Phone: 786-614-1320
  • Fax:
Mailing address:
  • Phone: 786-614-1320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-76325
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: