Healthcare Provider Details

I. General information

NPI: 1104580976
Provider Name (Legal Business Name): MS. LISET SAMPEDRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5280 NW 7TH ST APT 506
MIAMI FL
33126-3283
US

IV. Provider business mailing address

5280 NW 7TH ST APT 506
MIAMI FL
33126-3283
US

V. Phone/Fax

Practice location:
  • Phone: 305-588-7873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86694
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number21-153594
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-23-14927
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: