Healthcare Provider Details

I. General information

NPI: 1598026593
Provider Name (Legal Business Name): SUSANA ISAKHAROVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 SE 5TH ST
DANIA BEACH FL
33004-4143
US

IV. Provider business mailing address

203 SE 5TH ST
DANIA FL
33004-4143
US

V. Phone/Fax

Practice location:
  • Phone: 917-671-7094
  • Fax:
Mailing address:
  • Phone: 917-671-7094
  • Fax: 866-381-7544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: