Healthcare Provider Details

I. General information

NPI: 1881403046
Provider Name (Legal Business Name): YASMIT PIEDRA SACRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3114 LEE BLVD STE B
LEHIGH ACRES FL
33971-2421
US

IV. Provider business mailing address

506 FLAMINGO AVE
LEHIGH ACRES FL
33974-0563
US

V. Phone/Fax

Practice location:
  • Phone: 239-230-9971
  • Fax:
Mailing address:
  • Phone: 239-219-2272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB885545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: