Provider Demographics
NPI:1740889096
Name:URDANETA, SILVIA PATRICIA
Entity type:Individual
Prefix:
First Name:SILVIA
Middle Name:PATRICIA
Last Name:URDANETA
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 1:6241 SW 138TH CT APT A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2096
Mailing Address - Country:US
Mailing Address - Phone:786-381-5956
Mailing Address - Fax:
Practice Address - Street 1:6241 SW 138TH CT APT A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2096
Practice Address - Country:US
Practice Address - Phone:786-381-5956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-122150106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician