Healthcare Provider Details

I. General information

NPI: 1548188113
Provider Name (Legal Business Name): SUELLEN NEGRISOLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9864 GRAND VERDE WAY APT 1509
BOCA RATON FL
33428-3524
US

IV. Provider business mailing address

9864 GRAND VERDE WAY APT 1509
BOCA RATON FL
33428-3524
US

V. Phone/Fax

Practice location:
  • Phone: 561-695-7492
  • Fax:
Mailing address:
  • Phone: 561-695-7492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMT4555
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: