MEDICARE: IDELSY 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	106S00000X	Behavior Technician		FL

General Provider Information

NPI Number	:	1700473741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDELSY HERNANDEZ

Provider Business Mailing Address
First Line	:	3625 E GATOR CIR
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-7341
Country	:	US
Telephone Number	:	786-752-0524
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 DEL PRADO BLVD S STE 300
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-1724
Country	:	US
Telephone Number	:	239-471-2874
Fax Number	:	239-330-2919

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

Provider Enumeration Date	:	12/23/2020
Last Update Date	:	02/24/2026

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