Provider Demographics
NPI:1831872068
Name:RAVID, DYLAN
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:RAVID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4091 NE 16TH TER
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-5411
Mailing Address - Country:US
Mailing Address - Phone:954-557-7970
Mailing Address - Fax:
Practice Address - Street 1:4091 NE 16TH TER
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-5411
Practice Address - Country:US
Practice Address - Phone:954-557-7970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician