Healthcare Provider Details

I. General information

NPI: 1871047167
Provider Name (Legal Business Name): SADY MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6447 MIAMI LAKES DR
MIAMI LAKES FL
33014-2741
US

IV. Provider business mailing address

4472 SW 136TH PL
MIAMI FL
33175-3721
US

V. Phone/Fax

Practice location:
  • Phone: 305-640-5739
  • Fax:
Mailing address:
  • Phone: 786-515-7425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number19-84659
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1984659
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: