Provider Demographics
NPI:1518729813
Name:FUENTES CHACON, ADAYS
Entity Type:Individual
Prefix:
First Name:ADAYS
Middle Name:
Last Name:FUENTES CHACON
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 1:1710 E WAYCROSS CIR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-7662
Mailing Address - Country:US
Mailing Address - Phone:386-507-3067
Mailing Address - Fax:
Practice Address - Street 1:1710 E WAYCROSS CIR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-7662
Practice Address - Country:US
Practice Address - Phone:386-507-3067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-320907106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician