Provider Demographics
NPI:1467295659
Name:CASTANEDA SORIS, ELIANYS
Entity type:Individual
Prefix:
First Name:ELIANYS
Middle Name:
Last Name:CASTANEDA SORIS
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 1:750 NW 8TH ST APT 1307
Mailing Address - Street 2:
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034-2057
Mailing Address - Country:US
Mailing Address - Phone:786-682-0431
Mailing Address - Fax:
Practice Address - Street 1:750 NW 8TH ST APT 1307
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-2057
Practice Address - Country:US
Practice Address - Phone:786-682-0431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-350569106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty