Provider Demographics
NPI:1659064723
Name:ESTRADA, KAYLAN LEE
Entity Type:Individual
Prefix:
First Name:KAYLAN
Middle Name:LEE
Last Name:ESTRADA
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 1:6950 CYPRESS RD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2382
Mailing Address - Country:US
Mailing Address - Phone:954-399-5700
Mailing Address - Fax:
Practice Address - Street 1:6950 CYPRESS RD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2382
Practice Address - Country:US
Practice Address - Phone:954-399-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst