MEDICARE: SHELSYN GUTIERREZ GUERRA

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		FL

General Provider Information

NPI Number	:	1578405197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELSYN GUTIERREZ GUERRA

Provider Business Mailing Address
First Line	:	13404 SW 62ND ST APT L103
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-5053
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13404 SW 62ND ST APT L103
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-5053
Country	:	US
Telephone Number	:	754-265-9922
Fax Number	:

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

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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