Provider Demographics
NPI:1861087488
Name:DE LA TORRE SANCHEZ, YANELIS CARMEN
Entity type:Individual
Prefix:
First Name:YANELIS
Middle Name:CARMEN
Last Name:DE LA TORRE SANCHEZ
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 1:1955 BEACON LANDING CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-4366
Mailing Address - Country:US
Mailing Address - Phone:786-725-6175
Mailing Address - Fax:
Practice Address - Street 1:1955 BEACON LANDING CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-4366
Practice Address - Country:US
Practice Address - Phone:786-725-6175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2022-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL02113151106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108341000Medicaid