Provider Demographics
NPI:1508620055
Name:CARDONA, VANESSA KASSANDRA
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:KASSANDRA
Last Name:CARDONA
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 1:3214 SE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7228
Mailing Address - Country:US
Mailing Address - Phone:720-633-7507
Mailing Address - Fax:
Practice Address - Street 1:3214 SE 6TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7228
Practice Address - Country:US
Practice Address - Phone:720-633-7507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician