Provider Demographics
NPI:1528731361
Name:MORALES-PAVONI, YENISLEIDY
Entity type:Individual
Prefix:
First Name:YENISLEIDY
Middle Name:
Last Name:MORALES-PAVONI
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 1:22241 SW 93RD PL
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1225
Mailing Address - Country:US
Mailing Address - Phone:305-423-5759
Mailing Address - Fax:
Practice Address - Street 1:22241 SW 93RD PL
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1225
Practice Address - Country:US
Practice Address - Phone:305-423-5759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-171161106S00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician