Healthcare Provider Details

I. General information

NPI: 1821563362
Provider Name (Legal Business Name): SANDRA PUELLO ZALAYET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA PUELLO

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 SW 2ND CT
HOMESTEAD FL
33030-6675
US

IV. Provider business mailing address

2615 FAIRWAYS DR
HOMESTEAD FL
33035-1173
US

V. Phone/Fax

Practice location:
  • Phone: 888-880-9270
  • Fax:
Mailing address:
  • Phone: 800-920-1927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12477529
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0199798
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: