MEDICARE: MISS MICHELLE ANGELINA HERNANDEZ

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	106E00000X	Assistant Behavior Analyst	0-26-17191	FL

General Provider Information

NPI Number	:	1336910553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MICHELLE ANGELINA HERNANDEZ

Provider Business Mailing Address
First Line	:	12702 SW 228TH ST
Second Line	:
City	:	GOULDS
State	:	FL
Zip	:	33170-2753
Country	:	US
Telephone Number	:	863-349-6840
Fax Number	:

Provider Business Practice Location Address
First Line	:	12702 SW 228TH ST
Second Line	:
City	:	GOULDS
State	:	FL
Zip	:	33170-2753
Country	:	US
Telephone Number	:	863-349-6840
Fax Number	:

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

Provider Enumeration Date	:	01/16/2024
Last Update Date	:	06/02/2026

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