Provider Demographics
NPI:1891493664
Name:LEON CORRALES, ANYELA YANIESKA
Entity Type:Individual
Prefix:
First Name:ANYELA
Middle Name:YANIESKA
Last Name:LEON CORRALES
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 1:4633 DARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-1619
Mailing Address - Country:US
Mailing Address - Phone:407-690-9240
Mailing Address - Fax:
Practice Address - Street 1:4633 DARWOOD DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-1619
Practice Address - Country:US
Practice Address - Phone:407-690-9240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst