Provider Demographics
NPI:1245941731
Name:VALLADAREZ, ANDREA ALEJANDRA
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:ALEJANDRA
Last Name:VALLADAREZ
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 1:7720 FORDSON LN
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6734
Mailing Address - Country:US
Mailing Address - Phone:859-576-8139
Mailing Address - Fax:
Practice Address - Street 1:7720 FORDSON LN
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6734
Practice Address - Country:US
Practice Address - Phone:859-576-8139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY106S00000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician