Provider Demographics
NPI:1407607583
Name:ZELLERO MEDINA, NESLY
Entity type:Individual
Prefix:
First Name:NESLY
Middle Name:
Last Name:ZELLERO MEDINA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14524 SW 280TH ST APT 108
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8399
Mailing Address - Country:US
Mailing Address - Phone:305-522-5440
Mailing Address - Fax:
Practice Address - Street 1:103400 OVERSEAS HWY STE 240
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2849
Practice Address - Country:US
Practice Address - Phone:305-998-4248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-333514106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician