Healthcare Provider Details

I. General information

NPI: 1770968901
Provider Name (Legal Business Name): ANYLEC SUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17773 SW 2ND ST
PEMBROKE PINES FL
33029-3924
US

IV. Provider business mailing address

2521 NW 140TH ST
OPA LOCKA FL
33054-4062
US

V. Phone/Fax

Practice location:
  • Phone: 954-589-2347
  • Fax: 954-301-2246
Mailing address:
  • Phone: 786-314-4063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-17-7622
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: