Healthcare Provider Details

I. General information

NPI: 1851525513
Provider Name (Legal Business Name): SUSANA M CEDENO MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3481 NW 34TH ST
MIAMI FL
33142-5746
US

IV. Provider business mailing address

3481 NW 34TH ST
MIAMI FL
33142-5746
US

V. Phone/Fax

Practice location:
  • Phone: 786-553-3150
  • Fax: 305-422-2422
Mailing address:
  • Phone: 786-553-3150
  • Fax: 786-422-2422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License NumberMA 53469
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA14150
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: