Healthcare Provider Details

I. General information

NPI: 1730090267
Provider Name (Legal Business Name): DESYREE AVILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6740 SW 132ND ST
PINECREST FL
33156-6926
US

IV. Provider business mailing address

10240 REFLECTIONS BLVD APT 201
SUNRISE FL
33351-8313
US

V. Phone/Fax

Practice location:
  • Phone: 305-431-8358
  • Fax: 786-646-6115
Mailing address:
  • Phone: 813-808-3425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI6990
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: