Provider Demographics
NPI:1659592053
Name:CORONADO, JAMNY (MS)
Entity Type:Individual
Prefix:
First Name:JAMNY
Middle Name:
Last Name:CORONADO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16182 SW 61ST LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5798
Mailing Address - Country:US
Mailing Address - Phone:786-974-9200
Mailing Address - Fax:
Practice Address - Street 1:5040 NW 7TH ST STE 530
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3432
Practice Address - Country:US
Practice Address - Phone:305-995-0141
Practice Address - Fax:305-995-0144
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5319207Q00000X
FLIMH5319101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty