Healthcare Provider Details

I. General information

NPI: 1285318683
Provider Name (Legal Business Name): YUANNYS SMITH FONDIN I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 45TH ST STE 304
WEST PALM BEACH FL
33407-2011
US

IV. Provider business mailing address

4402 BOATMAN ST
LAKE WORTH FL
33461-3417
US

V. Phone/Fax

Practice location:
  • Phone: 561-328-9344
  • Fax:
Mailing address:
  • Phone: 786-779-9601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-148458
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: