Provider Demographics
NPI:1346789666
Name:FERNANDEZ ZALDIVAR, KEILYN SR
Entity Type:Individual
Prefix:
First Name:KEILYN
Middle Name:
Last Name:FERNANDEZ ZALDIVAR
Suffix:SR
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 1:16500 NW 17TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33054-6606
Mailing Address - Country:US
Mailing Address - Phone:561-386-8332
Mailing Address - Fax:
Practice Address - Street 1:16500 NW 17TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33054-6606
Practice Address - Country:US
Practice Address - Phone:561-386-8332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst