Provider Demographics
NPI:1659171734
Name:FUNDORA FERNANDEZ, MEYLI
Entity type:Individual
Prefix:
First Name:MEYLI
Middle Name:
Last Name:FUNDORA FERNANDEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 25TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33976
Mailing Address - Country:US
Mailing Address - Phone:239-785-6879
Mailing Address - Fax:
Practice Address - Street 1:3308 25TH ST SW
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33976
Practice Address - Country:US
Practice Address - Phone:239-785-6879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician