Provider Demographics
NPI:1881045516
Name:FIALLO, YANETSY (CBHCMS)
Entity Type:Individual
Prefix:
First Name:YANETSY
Middle Name:
Last Name:FIALLO
Suffix:
Gender:F
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19130 NW 80TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5211
Mailing Address - Country:US
Mailing Address - Phone:786-302-3162
Mailing Address - Fax:
Practice Address - Street 1:2300 W 84TH ST STE 406
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5780
Practice Address - Country:US
Practice Address - Phone:786-302-3162
Practice Address - Fax:786-398-5500
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator