Healthcare Provider Details

I. General information

NPI: 1679075071
Provider Name (Legal Business Name): SISSI VARELA ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9036 SW 152ND ST
PALMETTO BAY FL
33157-1928
US

IV. Provider business mailing address

16013 SW 101ST TER
MIAMI FL
33196-6162
US

V. Phone/Fax

Practice location:
  • Phone: 786-340-2687
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89897
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: