Provider Demographics
NPI:1174929202
Name:REYES, IISHA
Entity type:Individual
Prefix:
First Name:IISHA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IISHA
Other - Middle Name:B
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:671 MACDUFF LN
Mailing Address - Street 2:UNIT B
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5396
Mailing Address - Country:US
Mailing Address - Phone:321-368-2846
Mailing Address - Fax:
Practice Address - Street 1:671 MACDUFF LN
Practice Address - Street 2:UNIT B
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5396
Practice Address - Country:US
Practice Address - Phone:321-368-2846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health