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General NPI Number Information
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NPI Number | 1245856871
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Entity Type | Individual
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Provider Name | YUDAISY MIRANDA RBT
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Gender | Female
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Dates
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Enumeration Date | 06/19/2020
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Last Update Date | 06/19/2020
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Provider Practice Location Address
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Address Line | 2460 SW 137TH AVE STE 242
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City | MIAMI
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State | FL
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Zip | 33175-6399
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Country | US
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Telephone | 786-360-6496
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Fax | 786-534-3076
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Provider Business Mailing Address
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Address Line | 13451 SW 67TH ST
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City | MIAMI
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State | FL
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Zip | 33183-2353
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Country | US
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Telephone | 786-348-1728
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-20-123274
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License Number State | FL
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