Provider Demographics
NPI:1689287740
Name:DE VERA HERNANDEZ, MAIDELYS (RBT)
Entity Type:Individual
Prefix:
First Name:MAIDELYS
Middle Name:
Last Name:DE VERA HERNANDEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 WINDY WALK WAY APT 306
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7343
Mailing Address - Country:US
Mailing Address - Phone:786-682-7402
Mailing Address - Fax:
Practice Address - Street 1:14789 MAGNOLIA RIDGE LOOP
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5635
Practice Address - Country:US
Practice Address - Phone:321-444-8320
Practice Address - Fax:407-641-3926
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty