Provider Demographics
NPI:1457840407
Name:SANCHEZ, NIDYA LILITH (RBT-17-45094)
Entity Type:Individual
Prefix:
First Name:NIDYA
Middle Name:LILITH
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:RBT-17-45094
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 S LORRAINE RD APT 107
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-6925
Mailing Address - Country:US
Mailing Address - Phone:630-965-6658
Mailing Address - Fax:
Practice Address - Street 1:881 S LORRAINE RD APT 107
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-6925
Practice Address - Country:US
Practice Address - Phone:630-965-6658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-05
Last Update Date:2018-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17-45094106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician