Healthcare Provider Details

I. General information

NPI: 1376808295
Provider Name (Legal Business Name): JACQUELINE SUZETTE MATTHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8320 NW 193RD LN
HIALEAH FL
33015-5315
US

IV. Provider business mailing address

8320 NW 193RD LN
HIALEAH FL
33015-5315
US

V. Phone/Fax

Practice location:
  • Phone: 305-331-3522
  • Fax:
Mailing address:
  • Phone: 305-331-3522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: