Healthcare Provider Details

I. General information

NPI: 1073193991
Provider Name (Legal Business Name): BLESSED LEGACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2072 MAGUIRE AVE
SPRING HILL FL
34608-5037
US

IV. Provider business mailing address

2072 MAGUIRE AVE
SPRING HILL FL
34608-5037
US

V. Phone/Fax

Practice location:
  • Phone: 813-756-8056
  • Fax: 813-725-6424
Mailing address:
  • Phone: 954-638-3770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: YADIRA SUAREZ-PITA
Title or Position: OWNER
Credential: MS.ED., BCBA
Phone: 954-638-3770