MEDICARE: YISELLY VERA

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	RBT21-193557	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	:	1962152603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YISELLY VERA

Provider Business Mailing Address
First Line	:	2819 NW 4TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-8749
Country	:	US
Telephone Number	:	754-581-1169
Fax Number	:

Provider Business Practice Location Address
First Line	:	6660 ESTERO BLVD UNIT B404
Second Line	:
City	:	FORT MYERS BEACH
State	:	FL
Zip	:	33931-4567
Country	:	US
Telephone Number	:	239-691-6482
Fax Number	:

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

Provider Enumeration Date	:	03/25/2022
Last Update Date	:	03/25/2022

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Directions to “ YISELLY VERA ” Practice Location

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