Healthcare Provider Details

I. General information

NPI: 1124821301
Provider Name (Legal Business Name): ANTONIO SUAREZ PARADA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 S UNIVERSITY DR STE 207
DAVIE FL
33328-3811
US

IV. Provider business mailing address

625 NW 177TH ST APT 109
MIAMI FL
33169-6931
US

V. Phone/Fax

Practice location:
  • Phone: 800-484-6803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-414499
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: