Provider Demographics
NPI:1386280188
Name:AGUIAR, YENISLEY
Entity type:Individual
Prefix:MS
First Name:YENISLEY
Middle Name:
Last Name:AGUIAR
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 1:2500 SW 107TH AVE STE 40
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2492
Mailing Address - Country:US
Mailing Address - Phone:786-558-8724
Mailing Address - Fax:786-502-2380
Practice Address - Street 1:2500 SW 107TH AVE STE 40
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2492
Practice Address - Country:US
Practice Address - Phone:786-558-8724
Practice Address - Fax:786-502-2380
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-122348106S00000X
FLME131372207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110490200Medicaid