Healthcare Provider Details

I. General information

NPI: 1154789618
Provider Name (Legal Business Name): SULAY ROBERTS B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NW 14TH ST ROOM 1210
MIAMI FL
33136-2107
US

IV. Provider business mailing address

9884 N KENDALL DR APT H119
MIAMI FL
33176-1828
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6508
  • Fax:
Mailing address:
  • Phone: 917-995-5680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: