Provider Demographics
NPI:1780406355
Name:OBANDO, EBONY T
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:T
Last Name:OBANDO
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 1:26403 SW 134TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7767
Mailing Address - Country:US
Mailing Address - Phone:786-956-9369
Mailing Address - Fax:
Practice Address - Street 1:13195 SW 134TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4499
Practice Address - Country:US
Practice Address - Phone:844-424-4539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician