Active NPI
Yuderky Rodriguez Denis
- Behavior Technician
- Palm Bay, FL
National Provider Identifier
1225701485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 21-171796
- Practice address
- 418 Titan Rd SE
Palm Bay, FL 32909-8203 - Phone
- (361) 726-2980
- NPI assigned
- Jul 25, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 21-171796 | FL | Primary |
Addresses
Primary practice location
418 Titan Rd SE
Palm Bay, FL 32909-8203
Mailing address
418 Titan Rd SE
Palm Bay, FL 32909-8203
Phone (361) 726-2980
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110844300 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21-171796 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683763200000",
"number": "1225701485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "418 TITAN RD SE",
"city": "PALM BAY",
"state": "FL",
"postal_code": "329098203",
"telephone_number": "361-726-2980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "418 TITAN RD SE",
"city": "PALM BAY",
"state": "FL",
"postal_code": "329098203",
"telephone_number": "361-726-2980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ DENIS",
"first_name": "YUDERKY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-07-25",
"last_updated": "2023-05-11",
"certification_date": "2023-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "21-171796",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110844300",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Palm Bay, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.