Healthcare Provider Details

I. General information

NPI: 1619758729
Provider Name (Legal Business Name): ADILU SUSANA VIERA SENRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221 BARON ST
LEHIGH ACRES FL
33971-6591
US

IV. Provider business mailing address

5221 BARON ST
LEHIGH ACRES FL
33971-6591
US

V. Phone/Fax

Practice location:
  • Phone: 305-733-0097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-301599
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: