Healthcare Provider Details

I. General information

NPI: 1770174450
Provider Name (Legal Business Name): CIAIRA MILES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 N STATE ROAD 7 STE 300
LAUDERDALE LAKES FL
33319-5867
US

IV. Provider business mailing address

13545 FAIRDALE LN
SPRING HILL FL
34609-0730
US

V. Phone/Fax

Practice location:
  • Phone: 561-335-5681
  • Fax: 561-210-5502
Mailing address:
  • Phone: 727-237-6598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-134924
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-57677
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: