Provider Demographics
NPI:1316756653
Name:RODRIGUEZ FELICIANO, NASHALIE IVELYS
Entity type:Individual
Prefix:
First Name:NASHALIE
Middle Name:IVELYS
Last Name:RODRIGUEZ FELICIANO
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 1:317 HANEY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46613-2406
Mailing Address - Country:US
Mailing Address - Phone:863-557-3269
Mailing Address - Fax:
Practice Address - Street 1:1316 W DRAGOON TRL
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-4713
Practice Address - Country:US
Practice Address - Phone:574-855-4292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician