Provider Demographics
NPI:1083212427
Name:FERNANDEZ, JADIRA LYNETTE
Entity Type:Individual
Prefix:
First Name:JADIRA
Middle Name:LYNETTE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10035 SW 80TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4001
Mailing Address - Country:US
Mailing Address - Phone:786-973-8792
Mailing Address - Fax:
Practice Address - Street 1:10035 SW 80TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4001
Practice Address - Country:US
Practice Address - Phone:786-973-8792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health