Provider Demographics
NPI:1053136473
Name:HERNANDEZ RAYA, YANISLEYDI
Entity type:Individual
Prefix:
First Name:YANISLEYDI
Middle Name:
Last Name:HERNANDEZ RAYA
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 1:13775 SW 157TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1261
Mailing Address - Country:US
Mailing Address - Phone:305-484-7008
Mailing Address - Fax:
Practice Address - Street 1:13501 SW 128TH ST STE 114
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5014
Practice Address - Country:US
Practice Address - Phone:786-250-3440
Practice Address - Fax:786-364-1810
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-393775106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty