Provider Demographics
NPI:1548906654
Name:ZELAYA, ANGIE DAYANA
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:DAYANA
Last Name:ZELAYA
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 1:6465 W 24TH AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6992
Mailing Address - Country:US
Mailing Address - Phone:305-397-4059
Mailing Address - Fax:
Practice Address - Street 1:6465 W 24TH AVE APT 205
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-6992
Practice Address - Country:US
Practice Address - Phone:305-397-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-204308106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114090900Medicaid