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General NPI Number Information
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NPI Number | 1275038036
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Entity Type | Individual
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Provider Name | ENID YADIRA NIEVES ANDRADES
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Gender | Female
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 1887 SE PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-5530
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Country | US
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Telephone | 771-463-0444
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Fax | 772-219-1339
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Provider Business Mailing Address
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Address Line | 5064 BRILLIANCE CIR
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City | COCOA
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State | FL
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Zip | 32926-2493
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Country | US
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Telephone | 787-806-7242
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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 |
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License Number State |
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