Provider Demographics
NPI:1205725983
Name:REYES, ISALLANA
Entity type:Individual
Prefix:
First Name:ISALLANA
Middle Name:
Last Name:REYES
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 1:9830 ALTIS CIR E # 103
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6070
Mailing Address - Country:US
Mailing Address - Phone:786-424-1822
Mailing Address - Fax:
Practice Address - Street 1:14125 NW 80TH AVE STE 304
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-2351
Practice Address - Country:US
Practice Address - Phone:786-305-7222
Practice Address - Fax:786-535-7211
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25-1338193106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician