Healthcare Provider Details

I. General information

NPI: 1104472646
Provider Name (Legal Business Name): ISARY SURI CABRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 W VINE ST STE 115
KISSIMMEE FL
34741-4644
US

IV. Provider business mailing address

668 BIARRTZ CT
ORLANDO FL
32809-6515
US

V. Phone/Fax

Practice location:
  • Phone: 407-483-3074
  • Fax:
Mailing address:
  • Phone: 321-888-0350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI8164
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT1993648
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: