Provider Demographics
NPI:1528651619
Name:ANDELIZ, SOLANGIE
Entity type:Individual
Prefix:
First Name:SOLANGIE
Middle Name:
Last Name:ANDELIZ
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 1:10280 RIVERBEND TER
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6347
Mailing Address - Country:US
Mailing Address - Phone:347-924-1786
Mailing Address - Fax:
Practice Address - Street 1:10280 RIVERBEND TER
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-6347
Practice Address - Country:US
Practice Address - Phone:347-924-1786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB652496106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician