Provider Demographics
NPI:1437848975
Name:JAIME SANTISTEBAN, AMAURY YANDY
Entity Type:Individual
Prefix:
First Name:AMAURY
Middle Name:YANDY
Last Name:JAIME SANTISTEBAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4992 REGINA CT
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-9165
Mailing Address - Country:US
Mailing Address - Phone:561-673-0079
Mailing Address - Fax:
Practice Address - Street 1:3066 S JOG RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-2053
Practice Address - Country:US
Practice Address - Phone:561-788-4086
Practice Address - Fax:561-228-0540
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-267845106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician