Healthcare Provider Details

I. General information

NPI: 1558059519
Provider Name (Legal Business Name): TAMARA D MARTINEZ SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 SW 33RD TER
CAPE CORAL FL
33914-7819
US

IV. Provider business mailing address

18300 SW 98TH AVE APT 401
PALMETTO BAY FL
33157-5576
US

V. Phone/Fax

Practice location:
  • Phone: 239-922-8329
  • Fax:
Mailing address:
  • Phone: 239-922-8329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88303
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: