Provider Demographics
NPI:1538468970
Name:NARDO, MAILIN (LMT)
Entity Type:Individual
Prefix:
First Name:MAILIN
Middle Name:
Last Name:NARDO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13331 SW 59TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5157
Mailing Address - Country:US
Mailing Address - Phone:305-864-2311
Mailing Address - Fax:305-960-7568
Practice Address - Street 1:880 NE 69TH ST # 12
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-5760
Practice Address - Country:US
Practice Address - Phone:305-864-2311
Practice Address - Fax:305-960-7568
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60250111NR0400X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No111NR0400XChiropractic ProvidersChiropractorRehabilitation