Provider Demographics
NPI:1376421842
Name:ASTUDILLO, PAOLA ANDREA
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:ANDREA
Last Name:ASTUDILLO
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 1:1836 ARTHUR ST APT 16
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-3101
Mailing Address - Country:US
Mailing Address - Phone:786-759-9004
Mailing Address - Fax:
Practice Address - Street 1:9410 TANGERINE PL APT 403
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4443
Practice Address - Country:US
Practice Address - Phone:954-701-4987
Practice Address - Fax:855-532-9272
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-23
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1000229103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst