Provider Demographics
NPI:1568042190
Name:TEYRA, ARIANNA
Entity Type:Individual
Prefix:
First Name:ARIANNA
Middle Name:
Last Name:TEYRA
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 1:401 SW 18TH AVE APT 18
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3496
Mailing Address - Country:US
Mailing Address - Phone:786-587-3559
Mailing Address - Fax:
Practice Address - Street 1:401 SW 18TH AVE APT 18
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3496
Practice Address - Country:US
Practice Address - Phone:786-587-3559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician