Provider Demographics
NPI:1013495126
Name:NAIM, WADED PASTORA
Entity type:Individual
Prefix:
First Name:WADED
Middle Name:PASTORA
Last Name:NAIM
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 1:1008 LAKE BISCAYNE WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-4925
Mailing Address - Country:US
Mailing Address - Phone:407-319-1853
Mailing Address - Fax:
Practice Address - Street 1:1008 LAKE BISCAYNE WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-4925
Practice Address - Country:US
Practice Address - Phone:407-319-1853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT16-12636106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017577000Medicaid