Provider Demographics
NPI:1518729136
Name:DEL VALLE, JOHANY M
Entity Type:Individual
Prefix:
First Name:JOHANY
Middle Name:M
Last Name:DEL VALLE
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 1:339 SHAD WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-4730
Mailing Address - Country:US
Mailing Address - Phone:717-819-0263
Mailing Address - Fax:
Practice Address - Street 1:897 TOWNE CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3473
Practice Address - Country:US
Practice Address - Phone:407-201-4936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician