Healthcare Provider Details

I. General information

NPI: 1538083480
Provider Name (Legal Business Name): BRAYAN TERUEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 RIVERDALE ST UNIT 286
WAKEFIELD MA
01880
US

IV. Provider business mailing address

ER 7108 SOUTH KANNER HWY.
STUART FL
34997
US

V. Phone/Fax

Practice location:
  • Phone: 581-944-4419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: