Healthcare Provider Details

I. General information

NPI: 1811802952
Provider Name (Legal Business Name): SIRENA WALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99434 OVERSEAS HWY
KEY LARGO FL
33037-2459
US

IV. Provider business mailing address

15006 SW 308TH ST
HOMESTEAD FL
33033-4448
US

V. Phone/Fax

Practice location:
  • Phone: 305-440-3948
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number26-2839442
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: