Provider Demographics
NPI:1750827333
Name:MIRANDA CANSINO, ELIANY
Entity Type:Individual
Prefix:
First Name:ELIANY
Middle Name:
Last Name:MIRANDA CANSINO
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 1:13452 SW 280TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7359
Mailing Address - Country:US
Mailing Address - Phone:786-306-8795
Mailing Address - Fax:
Practice Address - Street 1:12085 SW 250TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-5971
Practice Address - Country:US
Practice Address - Phone:786-306-8795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician