Provider Demographics
NPI:1568351245
Name:FERNANDEZ PASTOR, HEYDI
Entity type:Individual
Prefix:
First Name:HEYDI
Middle Name:
Last Name:FERNANDEZ PASTOR
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 1:3616 PENNINGTON RD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-5042
Mailing Address - Country:US
Mailing Address - Phone:305-590-1270
Mailing Address - Fax:305-590-1270
Practice Address - Street 1:3616 PENNINGTON RD UNIT 3
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-5042
Practice Address - Country:US
Practice Address - Phone:305-590-1270
Practice Address - Fax:305-590-1270
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1281141106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician