Healthcare Provider Details

I. General information

NPI: 1508655671
Provider Name (Legal Business Name): DANIELLY SUTTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22655 BAYSHORE RD
PORT CHARLOTTE FL
33980-2018
US

IV. Provider business mailing address

3982 POMODORO CIR APT 303
CAPE CORAL FL
33909-5469
US

V. Phone/Fax

Practice location:
  • Phone: 941-451-9743
  • Fax: 239-310-2045
Mailing address:
  • Phone: 786-360-9886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-425367
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: