Healthcare Provider Details

I. General information

NPI: 1104562008
Provider Name (Legal Business Name): STEPHANY ULLOA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12855 SW 132ND ST STE 102
MIAMI FL
33186-7209
US

IV. Provider business mailing address

12855 SW 132ND ST STE 102
MIAMI FL
33186-7209
US

V. Phone/Fax

Practice location:
  • Phone: 305-781-3273
  • Fax:
Mailing address:
  • Phone: 305-781-3273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86488
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-212027
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: