Provider Demographics
NPI:1689338865
Name:ALFONSO PRADO, YENISLEIDYS
Entity Type:Individual
Prefix:
First Name:YENISLEIDYS
Middle Name:
Last Name:ALFONSO PRADO
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 1:9493 SW 76TH ST APT L7
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3391
Mailing Address - Country:US
Mailing Address - Phone:786-447-3533
Mailing Address - Fax:
Practice Address - Street 1:12260 SW 8TH ST STE 156
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1508
Practice Address - Country:US
Practice Address - Phone:786-332-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician