Provider Demographics
NPI:1790253102
Name:ALDANA, MAGALY BEATRIZ
Entity Type:Individual
Prefix:
First Name:MAGALY
Middle Name:BEATRIZ
Last Name:ALDANA
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 1:1200 N CENTRAL AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4439
Mailing Address - Country:US
Mailing Address - Phone:407-530-5063
Mailing Address - Fax:877-399-5578
Practice Address - Street 1:4625 BIG ISLAND DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-3497
Practice Address - Country:US
Practice Address - Phone:407-535-9973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023136700Medicaid