Provider Demographics
NPI:1093598427
Name:BALDAYO JUAREZ, KIANCY ALEJANDRA
Entity Type:Individual
Prefix:
First Name:KIANCY
Middle Name:ALEJANDRA
Last Name:BALDAYO JUAREZ
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 1:4763 SW 66TH TER
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4324
Mailing Address - Country:US
Mailing Address - Phone:845-480-8893
Mailing Address - Fax:
Practice Address - Street 1:4763 SW 66TH TER
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4324
Practice Address - Country:US
Practice Address - Phone:845-480-8893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT23287665106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician