Provider Demographics
NPI:1962124735
Name:ALEJO MEDINA, NAYANI
Entity type:Individual
Prefix:
First Name:NAYANI
Middle Name:
Last Name:ALEJO MEDINA
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 1:14310 SW 156TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1076
Mailing Address - Country:US
Mailing Address - Phone:203-963-0334
Mailing Address - Fax:
Practice Address - Street 1:14310 SW 156TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1076
Practice Address - Country:US
Practice Address - Phone:203-963-0334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician