Healthcare Provider Details

I. General information

NPI: 1861309726
Provider Name (Legal Business Name): STEPHANIE ALEXANDRA LEIVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19001 SW 106TH AVE STE 107
CUTLER BAY FL
33157-7671
US

IV. Provider business mailing address

8540 SW 133RD AVENUE RD APT 102
MIAMI FL
33183-4507
US

V. Phone/Fax

Practice location:
  • Phone: 305-378-5775
  • Fax:
Mailing address:
  • Phone: 786-909-4315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI7896
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: