Provider Demographics
NPI:1710469010
Name:AFANADOR REVERON, GINNETTE MILENA (AUD)
Entity Type:Individual
Prefix:
First Name:GINNETTE
Middle Name:MILENA
Last Name:AFANADOR REVERON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9034 SW 97TH AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2092
Mailing Address - Country:US
Mailing Address - Phone:787-502-7938
Mailing Address - Fax:
Practice Address - Street 1:8947 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1412
Practice Address - Country:US
Practice Address - Phone:305-595-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2224231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist