Provider Demographics
NPI:1497587109
Name:BALADA, ANAIDYS
Entity type:Individual
Prefix:
First Name:ANAIDYS
Middle Name:
Last Name:BALADA
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 1:110 ROYAL PALM RD APT 111
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4604
Mailing Address - Country:US
Mailing Address - Phone:786-443-3733
Mailing Address - Fax:
Practice Address - Street 1:110 ROYAL PALM RD APT 111
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-4604
Practice Address - Country:US
Practice Address - Phone:786-443-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-122736106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician