Provider Demographics
NPI:1417432279
Name:BADIAU, GLAVDYA (BA)
Entity Type:Individual
Prefix:
First Name:GLAVDYA
Middle Name:
Last Name:BADIAU
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 SHORESIDE DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-1965
Mailing Address - Country:US
Mailing Address - Phone:321-697-2393
Mailing Address - Fax:
Practice Address - Street 1:3812 SHORESIDE DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-1965
Practice Address - Country:US
Practice Address - Phone:321-697-2393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician