Provider Demographics
NPI:1053801142
Name:SONORA DURAN, YANET
Entity type:Individual
Prefix:
First Name:YANET
Middle Name:
Last Name:SONORA DURAN
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 1:431 NW 82ND AVE APT 911
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-8351
Mailing Address - Country:US
Mailing Address - Phone:786-655-3334
Mailing Address - Fax:
Practice Address - Street 1:10482 SW 26TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2763
Practice Address - Country:US
Practice Address - Phone:786-655-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BCABA-0-20-11115106E00000X
BCBA1-21-55105103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022754900Medicaid