MEDICARE: MR. FREDY HERNANDEZ DELGADO RBT

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	103K00000X	Behavior Analyst	1-26-90352	SC

General Provider Information

NPI Number	:	1982412755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FREDY HERNANDEZ DELGADO RBT

Provider Business Mailing Address
First Line	:	472 TULIP POPLAR DR
Second Line	:
City	:	MONCKS CORNER
State	:	SC
Zip	:	29461-5284
Country	:	US
Telephone Number	:	786-992-9817
Fax Number	:	772-675-9100

Provider Business Practice Location Address
First Line	:	355 S MAIN ST FL 1
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2923
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:	772-675-9100

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

Provider Enumeration Date	:	12/24/2024
Last Update Date	:	06/09/2026

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