Provider Demographics
NPI:1760239081
Name:ALEJO FERNANDEZ, ARADAY
Entity type:Individual
Prefix:
First Name:ARADAY
Middle Name:
Last Name:ALEJO 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 1:104 LAS BRISAS WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-4338
Mailing Address - Country:US
Mailing Address - Phone:321-443-7989
Mailing Address - Fax:
Practice Address - Street 1:104 LAS BRISAS WAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-4338
Practice Address - Country:US
Practice Address - Phone:321-443-7989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician