Healthcare Provider Details

I. General information

NPI: 1053239558
Provider Name (Legal Business Name): SASSANAE MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 W OAKLAND PARK BLVD STE B102
SUNRISE FL
33351-6741
US

IV. Provider business mailing address

7800 W OAKLAND PARK BLVD STE B102
SUNRISE FL
33351-6741
US

V. Phone/Fax

Practice location:
  • Phone: 954-999-0541
  • Fax: 954-999-0612
Mailing address:
  • Phone: 954-999-0541
  • Fax: 954-999-0612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: