Provider Demographics
NPI:1174045264
Name:DEKONY CARDONA, MIGUEL
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:
Last Name:DEKONY CARDONA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8617 E COLONIAL DR STE 1100
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-3919
Mailing Address - Country:US
Mailing Address - Phone:407-895-0801
Mailing Address - Fax:
Practice Address - Street 1:8617 E COLONIAL DR STE 1100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-3919
Practice Address - Country:US
Practice Address - Phone:407-895-0901
Practice Address - Fax:407-930-2569
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician