MEDICARE: SUSSEL SANCHEZ DAMAS I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-24-358401	FL

General Provider Information

NPI Number	:	1265278832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSSEL SANCHEZ DAMAS I

Provider Business Mailing Address
First Line	:	2308 MONROE ST APT 4
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-5398
Country	:	US
Telephone Number	:	305-636-8812
Fax Number	:

Provider Business Practice Location Address
First Line	:	2308 MONROE ST APT 4
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-5398
Country	:	US
Telephone Number	:	305-636-8812
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2024
Last Update Date	:	07/03/2024

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Directions to “ SUSSEL SANCHEZ DAMAS I ” Practice Location

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