Healthcare Provider Details

I. General information

NPI: 1982123352
Provider Name (Legal Business Name): MARANYELIN QUEZADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2017
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8610 HIDDEN RIVER PKWY STE 200
TAMPA FL
33637-1114
US

IV. Provider business mailing address

950 MOUNT BENEVOLENCE RD
NEWTON NJ
07860-4321
US

V. Phone/Fax

Practice location:
  • Phone: 813-481-9662
  • Fax: 813-704-2600
Mailing address:
  • Phone: 646-384-1762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-68446
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number1166051171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: