Healthcare Provider Details

I. General information

NPI: 1407392459
Provider Name (Legal Business Name): AMY ERIKA SUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2017
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 NW 123RD PATH
MIAMI FL
33182-2050
US

IV. Provider business mailing address

684 NW 123RD PATH
MIAMI FL
33182-2050
US

V. Phone/Fax

Practice location:
  • Phone: 786-312-0285
  • Fax:
Mailing address:
  • Phone: 786-312-0285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: