Healthcare Provider Details

I. General information

NPI: 1750254249
Provider Name (Legal Business Name): SUSANA LLANEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11781 SAINT ANDREWS PL APT 105
WELLINGTON FL
33414-7087
US

IV. Provider business mailing address

11781 SAINT ANDREWS PL APT 105
WELLINGTON FL
33414-7087
US

V. Phone/Fax

Practice location:
  • Phone: 561-461-7273
  • Fax:
Mailing address:
  • Phone: 561-461-7273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-476654
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: