Provider Demographics
NPI:1215479852
Name:NEYRA, MARIA ELENA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:NEYRA
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 1:4370 NW 107TH AVE APT 108
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1879
Mailing Address - Country:US
Mailing Address - Phone:786-286-8507
Mailing Address - Fax:
Practice Address - Street 1:4370 NW 107TH AVE APT 108
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-1879
Practice Address - Country:US
Practice Address - Phone:786-286-8507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-16-14066106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician