Healthcare Provider Details

I. General information

NPI: 1154683159
Provider Name (Legal Business Name): SUWENDA LOUIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 E NEWPORT CENTER DR STE 101
DEERFIELD BEACH FL
33442-7711
US

IV. Provider business mailing address

541 SW 63RD AVE
MARGATE FL
33068-1730
US

V. Phone/Fax

Practice location:
  • Phone: 754-444-3707
  • Fax:
Mailing address:
  • Phone: 754-214-9842
  • Fax: 954-577-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-30663
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: