Provider Demographics
NPI:1235919002
Name:HERNANDEZ, JAYDEL
Entity Type:Individual
Prefix:
First Name:JAYDEL
Middle Name:
Last Name:HERNANDEZ
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 1:11 BEDFORD AVE APT L2
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3841
Mailing Address - Country:US
Mailing Address - Phone:203-252-9614
Mailing Address - Fax:
Practice Address - Street 1:1445 E PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1379
Practice Address - Country:US
Practice Address - Phone:203-622-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician