Provider Demographics
NPI:1528601317
Name:VEGA HERNANDEZ, SHEILA (BCABA)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:VEGA HERNANDEZ
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10876 SW 229TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-7517
Mailing Address - Country:US
Mailing Address - Phone:786-547-7103
Mailing Address - Fax:
Practice Address - Street 1:10876 SW 229TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-7517
Practice Address - Country:US
Practice Address - Phone:786-547-7103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB408460106E00000X
FL1-21-55813103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst