Provider Demographics
NPI:1659151215
Name:TADEO FERNANDEZ, MIGDALYS
Entity Type:Individual
Prefix:
First Name:MIGDALYS
Middle Name:
Last Name:TADEO FERNANDEZ
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 1:3337 W 90TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-2005
Mailing Address - Country:US
Mailing Address - Phone:786-312-7719
Mailing Address - Fax:
Practice Address - Street 1:3337 W 90TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-2005
Practice Address - Country:US
Practice Address - Phone:786-312-7719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT20-142241106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician