Healthcare Provider Details

I. General information

NPI: 1205395696
Provider Name (Legal Business Name): CHANDLY DUBREUZE II BCABA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 W HILLSBORO BLVD STE B12
COCONUT CREEK FL
33073-4365
US

IV. Provider business mailing address

8785 SW 165TH AVE STE 103
MIAMI FL
33193-5827
US

V. Phone/Fax

Practice location:
  • Phone: 754-399-8507
  • Fax:
Mailing address:
  • Phone: 786-206-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-22-13999
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: