Provider Demographics
NPI:1619562014
Name:MONTANES FERNANDEZ, SINDY
Entity type:Individual
Prefix:
First Name:SINDY
Middle Name:
Last Name:MONTANES FERNANDEZ
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 1:8105 TANGLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4636
Mailing Address - Country:US
Mailing Address - Phone:619-623-2938
Mailing Address - Fax:
Practice Address - Street 1:8105 TANGLEWOOD LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4636
Practice Address - Country:US
Practice Address - Phone:619-623-2938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CORBT-20-140917106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst