Provider Demographics
NPI:1447921697
Name:BUCHILLON, FARADAY
Entity type:Individual
Prefix:MR
First Name:FARADAY
Middle Name:
Last Name:BUCHILLON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:FARDAY
Other - Middle Name:
Other - Last Name:BUCHILLON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2444 SW 7TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3022
Mailing Address - Country:US
Mailing Address - Phone:786-442-6240
Mailing Address - Fax:
Practice Address - Street 1:7579 SW 28TH STREET RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2715
Practice Address - Country:US
Practice Address - Phone:561-460-0284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-126968106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician