Provider Demographics
NPI:1326827254
Name:VELAZQUEZ, ESTEFANY ANDREINA
Entity Type:Individual
Prefix:
First Name:ESTEFANY
Middle Name:ANDREINA
Last Name:VELAZQUEZ
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 1:8800 W SAMPLE RD APT 6
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4441
Mailing Address - Country:US
Mailing Address - Phone:954-348-1574
Mailing Address - Fax:
Practice Address - Street 1:8800 W SAMPLE RD APT 6
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4441
Practice Address - Country:US
Practice Address - Phone:954-348-1574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-297856106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician