Healthcare Provider Details

I. General information

NPI: 1104665868
Provider Name (Legal Business Name): MARCELO SIERRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 NW 17TH AVE STE 272
DELRAY BEACH FL
33445-2562
US

IV. Provider business mailing address

7108 S KANNER HWY
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 561-865-7064
  • Fax: 561-501-5413
Mailing address:
  • Phone: 855-832-6727
  • Fax: 772-675-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1262841897
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: