Provider Demographics
NPI:1093162802
Name:ESTEVEZ, MISLADYS
Entity Type:Individual
Prefix:MS
First Name:MISLADYS
Middle Name:
Last Name:ESTEVEZ
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 1:3182 W 73RD PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5263
Mailing Address - Country:US
Mailing Address - Phone:786-908-5052
Mailing Address - Fax:
Practice Address - Street 1:3182 W 73RD PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-5263
Practice Address - Country:US
Practice Address - Phone:786-908-5052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-22
Last Update Date:2016-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-15-07199103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-15-07199Medicaid