Healthcare Provider Details

I. General information

NPI: 1629903661
Provider Name (Legal Business Name): SARA SHELY PEREZ HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6808 SANTA FE S # 115
LABELLE FL
33935-5524
US

IV. Provider business mailing address

6808 SANTA FE S # 115
LABELLE FL
33935-5524
US

V. Phone/Fax

Practice location:
  • Phone: 786-747-2362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT26506556
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: