Healthcare Provider Details

I. General information

NPI: 1245704899
Provider Name (Legal Business Name): SUHEY MEJIA REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11639 NW 18TH PL
OCALA FL
34482-7935
US

IV. Provider business mailing address

11639 NW 18TH PL
OCALA FL
34482-7935
US

V. Phone/Fax

Practice location:
  • Phone: 352-209-5596
  • Fax:
Mailing address:
  • Phone: 352-209-5596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberM26278079610
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberM26278079610
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: