Healthcare Provider Details

I. General information

NPI: 1225698434
Provider Name (Legal Business Name): JANYFEL AMAGDYS COLON VALENTIN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 ZONA INDUSTRIAL REPARADA 2 CALLE DR LUIS F SALA
PONCE PR
00716-2348
US

IV. Provider business mailing address

URB COLINAS DE FAIRVIEW 4L50 CALLE 211A
TRUJILLO ALTO PR
00976
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-2575
  • Fax:
Mailing address:
  • Phone: 787-647-7037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6756
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number6756
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6756
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: