Provider Demographics
NPI:1417541905
Name:MUNOZ DELGADO, YANEISY C
Entity Type:Individual
Prefix:
First Name:YANEISY
Middle Name:C
Last Name:MUNOZ DELGADO
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 1:751 JAMESTOWN DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3642
Mailing Address - Country:US
Mailing Address - Phone:407-716-6219
Mailing Address - Fax:
Practice Address - Street 1:751 JAMESTOWN DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3642
Practice Address - Country:US
Practice Address - Phone:407-716-6219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-116642106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty