Provider Demographics
NPI:1639658214
Name:CONEJERO, ISLEY
Entity Type:Individual
Prefix:MS
First Name:ISLEY
Middle Name:
Last Name:CONEJERO
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 1:3119 NW 68TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-6635
Mailing Address - Country:US
Mailing Address - Phone:786-597-4152
Mailing Address - Fax:
Practice Address - Street 1:9201 NW 32ND AVE APT S
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-2933
Practice Address - Country:US
Practice Address - Phone:786-597-4152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020053400Medicaid
FL020100000Medicaid