Provider Demographics
NPI:1972028967
Name:CHAVIANO, YANEISI
Entity type:Individual
Prefix:
First Name:YANEISI
Middle Name:
Last Name:CHAVIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YANEISI
Other - Middle Name:
Other - Last Name:CHAVIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:705 TRUMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33972-4515
Mailing Address - Country:US
Mailing Address - Phone:305-803-5134
Mailing Address - Fax:
Practice Address - Street 1:705 TRUMAN AVE
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33972-4515
Practice Address - Country:US
Practice Address - Phone:305-803-5134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL0-21-11933106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician