Healthcare Provider Details

I. General information

NPI: 1023906179
Provider Name (Legal Business Name): SUILEN CUELLAR SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8254 MALVERN CIR
TAMPA FL
33634-2243
US

IV. Provider business mailing address

8254 MALVERN CIR
TAMPA FL
33634-2243
US

V. Phone/Fax

Practice location:
  • Phone: 813-606-3531
  • Fax:
Mailing address:
  • Phone: 813-606-3531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25-439042
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: