Healthcare Provider Details

I. General information

NPI: 1821619933
Provider Name (Legal Business Name): LISANDRA MONTANO BARRETO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15749 SW 101ST ST
MIAMI FL
33196-6121
US

IV. Provider business mailing address

15749 SW 101ST ST
MIAMI FL
33196-6121
US

V. Phone/Fax

Practice location:
  • Phone: 786-445-2260
  • Fax:
Mailing address:
  • Phone: 786-445-2260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11030228
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-78554
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11030228
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: