MEDICARE: GEIDY DE LAS MERCEDES MENDEZ REYES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	20-124772	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265105449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEIDY DE LAS MERCEDES MENDEZ REYES

Provider Business Mailing Address
First Line	:	3431 W 80TH ST APT 202
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-7572
Country	:	US
Telephone Number	:	305-903-7724
Fax Number	:

Provider Business Practice Location Address
First Line	:	3431 W 80TH ST APT 202
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-7572
Country	:	US
Telephone Number	:	305-903-7724
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2021
Last Update Date	:	07/26/2021

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Directions to “ GEIDY DE LAS MERCEDES MENDEZ REYES ” Practice Location

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