Provider Demographics
NPI:1831945120
Name:NOVOA CADALSO, HAIDYS V
Entity type:Individual
Prefix:
First Name:HAIDYS
Middle Name:V
Last Name:NOVOA CADALSO
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 1:4722 18TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-4516
Mailing Address - Country:US
Mailing Address - Phone:786-675-2841
Mailing Address - Fax:
Practice Address - Street 1:5100 78TH AVE N STE 6
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2407
Practice Address - Country:US
Practice Address - Phone:727-317-7916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT24--334103106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician