Provider Demographics
NPI:1609380351
Name:FERNANDEZ VALDES, SHANDRI
Entity Type:Individual
Prefix:
First Name:SHANDRI
Middle Name:
Last Name:FERNANDEZ VALDES
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 1:3040 OASIS GRAND BLVD APT 1006
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-1536
Mailing Address - Country:US
Mailing Address - Phone:305-299-7289
Mailing Address - Fax:
Practice Address - Street 1:8803 TAMIAMI TRL E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-3347
Practice Address - Country:US
Practice Address - Phone:239-351-4787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician