Provider Demographics
NPI:1841011087
Name:ORDUNEZ, MADISSON M
Entity type:Individual
Prefix:
First Name:MADISSON
Middle Name:M
Last Name:ORDUNEZ
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 1:851 CRAWFORD AVE SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-4610
Mailing Address - Country:US
Mailing Address - Phone:786-717-3042
Mailing Address - Fax:
Practice Address - Street 1:851 CRAWFORD AVE SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-4610
Practice Address - Country:US
Practice Address - Phone:786-717-3042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-377590106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician