Provider Demographics
NPI:1477922060
Name:CHAVIANO, LEIDY
Entity type:Individual
Prefix:
First Name:LEIDY
Middle Name:
Last Name:CHAVIANO
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 1:13205 SW 137TH AVE
Mailing Address - Street 2:SUITE 126
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5331
Mailing Address - Country:US
Mailing Address - Phone:786-224-1950
Mailing Address - Fax:786-671-3152
Practice Address - Street 1:13205 SW 137TH AVE
Practice Address - Street 2:SUITE 126
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5331
Practice Address - Country:US
Practice Address - Phone:786-224-1950
Practice Address - Fax:786-671-3152
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA66386225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist