Healthcare Provider Details

I. General information

NPI: 1902655491
Provider Name (Legal Business Name): SANDRA LLANES ZAYAS BAZAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11827 SW 105TH TER
MIAMI FL
33186-3961
US

IV. Provider business mailing address

11827 SW 105TH TER
MIAMI FL
33186-3961
US

V. Phone/Fax

Practice location:
  • Phone: 404-953-1597
  • Fax:
Mailing address:
  • Phone: 404-953-1597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: