Healthcare Provider Details

I. General information

NPI: 1235337197
Provider Name (Legal Business Name): SOPHIE GUELLATI-SALCEDO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 02/09/2022
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7808 SW 102ND LN
MIAMI FL
33156-2691
US

IV. Provider business mailing address

7808 SW 102ND LN
MIAMI FL
33156-2691
US

V. Phone/Fax

Practice location:
  • Phone: 305-799-9970
  • Fax:
Mailing address:
  • Phone: 305-799-9970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPY7490
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7490
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: