Provider Demographics
NPI:1225616873
Name:FERRALES BERMUDEZ, ANIURYS CARIDAD
Entity Type:Individual
Prefix:
First Name:ANIURYS
Middle Name:CARIDAD
Last Name:FERRALES BERMUDEZ
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 1:1156 HANCOCK CREEK SOUTH BLVD APT 201
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-5183
Mailing Address - Country:US
Mailing Address - Phone:239-747-3538
Mailing Address - Fax:
Practice Address - Street 1:1156 HANCOCK CREEK SOUTH BLVD APT 201
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-5183
Practice Address - Country:US
Practice Address - Phone:239-747-3538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB617537106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician