Provider Demographics
NPI:1093252181
Name:CALDERON, YANEISY
Entity Type:Individual
Prefix:
First Name:YANEISY
Middle Name:
Last Name:CALDERON
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 1:2925 W 80TH ST APT 228
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-3835
Mailing Address - Country:US
Mailing Address - Phone:786-317-7131
Mailing Address - Fax:
Practice Address - Street 1:2925 W 80TH ST APT 228
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-3835
Practice Address - Country:US
Practice Address - Phone:786-317-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 70606261QH0100X
FLRBT2012681106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service