Provider Demographics
NPI:1154889806
Name:HERNANDEZ, YANEISY (OTR)
Entity type:Individual
Prefix:
First Name:YANEISY
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18840 NW 48TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2548
Mailing Address - Country:US
Mailing Address - Phone:352-497-9694
Mailing Address - Fax:
Practice Address - Street 1:5470 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2105
Practice Address - Country:US
Practice Address - Phone:305-456-2646
Practice Address - Fax:305-967-8442
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT19896225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist