Provider Demographics
NPI:1043182249
Name:ALFONSO SARDINAS, YAIMA
Entity type:Individual
Prefix:
First Name:YAIMA
Middle Name:
Last Name:ALFONSO SARDINAS
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 1:4507 9TH ST W APT D5
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-1413
Mailing Address - Country:US
Mailing Address - Phone:786-819-5878
Mailing Address - Fax:
Practice Address - Street 1:4507 9TH ST W APT D5
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1413
Practice Address - Country:US
Practice Address - Phone:786-819-5878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-473210106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty