Healthcare Provider Details

I. General information

NPI: 1306794656
Provider Name (Legal Business Name): YAMILETH J MADRID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 SUNNY SKY LN SW
ALBUQUERQUE NM
87121-2617
US

IV. Provider business mailing address

7108 SOUTH KANNER HWY, STUART, FL 34997-7462 7108 SOUTH KANNER HWY, STUART, FL 34997-7462
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 505-304-9137
  • Fax:
Mailing address:
  • Phone: 185-583-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: