Provider Demographics
NPI:1881572212
Name:YORIS FERNANDEZ, EDNA
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:YORIS 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 1:220 LAKEVIEW DR APT 301
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1050
Mailing Address - Country:US
Mailing Address - Phone:954-548-1069
Mailing Address - Fax:
Practice Address - Street 1:220 LAKEVIEW DR APT 301
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-1050
Practice Address - Country:US
Practice Address - Phone:954-548-1069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician