Provider Demographics
NPI:1770113664
Name:RODRIGUEZ DELGADO, ANAYANCY
Entity type:Individual
Prefix:
First Name:ANAYANCY
Middle Name:
Last Name:RODRIGUEZ DELGADO
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 1:17564 PHLOX DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-2820
Mailing Address - Country:US
Mailing Address - Phone:239-465-2547
Mailing Address - Fax:
Practice Address - Street 1:17564 PHLOX DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33967-2820
Practice Address - Country:US
Practice Address - Phone:239-465-2547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician