Provider Demographics
NPI:1144197955
Name:FONTALVO MENDEZ, STAINELY J
Entity type:Individual
Prefix:
First Name:STAINELY
Middle Name:J
Last Name:FONTALVO MENDEZ
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 1:16816 SW 137TH AVE APT 1202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2478
Mailing Address - Country:US
Mailing Address - Phone:786-554-1756
Mailing Address - Fax:
Practice Address - Street 1:16816 SW 137TH AVE APT 1202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-2478
Practice Address - Country:US
Practice Address - Phone:786-554-1756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-479990106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician