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General NPI Number Information
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NPI Number | 1861078842
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Entity Type | Individual
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Provider Name | KEIRY CANDELARIO
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Gender | Female
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Dates
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Enumeration Date | 03/22/2021
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Last Update Date | 03/22/2021
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Provider Practice Location Address
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Address Line | 9050 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6455
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Country | US
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Telephone | 954-706-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 620 NE 177TH ST
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-2015
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Country | US
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Telephone | 786-267-4276
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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-18-66093
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License Number State | ZZ
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