Provider Demographics
NPI:1275199945
Name:CHEDA CARABALLO, ANAYS CARIDAD
Entity Type:Individual
Prefix:
First Name:ANAYS
Middle Name:CARIDAD
Last Name:CHEDA CARABALLO
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 1:14221 SW 120TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4224
Mailing Address - Country:US
Mailing Address - Phone:786-391-2935
Mailing Address - Fax:
Practice Address - Street 1:4060 SW 97TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5121
Practice Address - Country:US
Practice Address - Phone:786-328-0277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty