Individual
ALY VIDAURRI-MIELKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5175 45TH ST N # 4, ST PETERSBURG, FL 33714-2266
(727) 748-4060
(727) 748-4060
Mailing address
5175 45TH ST N # 4, ST PETERSBURG, FL 33714-2266
(727) 748-4060
(727) 748-4060
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/01/2021
Last updated
02/01/2021
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