Provider Demographics
NPI:1164025870
Name:ROSELL, MAGDELYS
Entity Type:Individual
Prefix:
First Name:MAGDELYS
Middle Name:
Last Name:ROSELL
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 1:21945 SW 104TH CT APT 205
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1078
Mailing Address - Country:US
Mailing Address - Phone:786-274-2893
Mailing Address - Fax:
Practice Address - Street 1:21945 SW 104TH CT APT 205
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1078
Practice Address - Country:US
Practice Address - Phone:786-274-2893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician