Healthcare Provider Details

I. General information

NPI: 1336025402
Provider Name (Legal Business Name): VERLLYER SPANOZ-VERDECIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5116 43RD AVE W
BRADENTON FL
34209-6722
US

IV. Provider business mailing address

5116 43RD AVE W
BRADENTON FL
34209-6722
US

V. Phone/Fax

Practice location:
  • Phone: 941-565-8958
  • Fax:
Mailing address:
  • Phone: 941-565-8958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: