Healthcare Provider Details

I. General information

NPI: 1184556912
Provider Name (Legal Business Name): ANDREA MIREYA CUENCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 N STATE ROAD 7 STE 20
COCONUT CREEK FL
33073-4379
US

IV. Provider business mailing address

3349 CELEBRATION LN
MARGATE FL
33063-8215
US

V. Phone/Fax

Practice location:
  • Phone: 954-228-5716
  • Fax:
Mailing address:
  • Phone: 954-770-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26-509102
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: