Provider Demographics
NPI:1811705965
Name:CREGO AYO, YOSDENIS
Entity type:Individual
Prefix:
First Name:YOSDENIS
Middle Name:
Last Name:CREGO AYO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9286 SW 220TH TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190
Mailing Address - Country:US
Mailing Address - Phone:786-972-2195
Mailing Address - Fax:
Practice Address - Street 1:9286 SW 220TH TER
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190
Practice Address - Country:US
Practice Address - Phone:786-972-2195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-399495106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty