Provider Demographics
NPI:1245856871
Name:MIRANDA, YUDAISY (RBT)
Entity type:Individual
Prefix:
First Name:YUDAISY
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13451 SW 67TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2353
Mailing Address - Country:US
Mailing Address - Phone:786-348-1728
Mailing Address - Fax:
Practice Address - Street 1:2460 SW 137TH AVE STE 242
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6399
Practice Address - Country:US
Practice Address - Phone:786-360-6496
Practice Address - Fax:786-534-3076
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-123274106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician