Provider Demographics
NPI:1942912522
Name:WILSON, NAIYAH ALEXANDRIA-NUNEZ
Entity Type:Individual
Prefix:
First Name:NAIYAH
Middle Name:ALEXANDRIA-NUNEZ
Last Name:WILSON
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 1:17101 GUILFORD CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32820-1410
Mailing Address - Country:US
Mailing Address - Phone:407-790-1750
Mailing Address - Fax:
Practice Address - Street 1:6973 UNIVERSITY BLVD FL 32792
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-6713
Practice Address - Country:US
Practice Address - Phone:888-754-0398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician