=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164248738
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENDA MARTIN AMEIJEIRAS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2024
-----------------------------------------------------
Last Update Date | 12/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 531 SW 6TH CT OFC 2
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33130-2793
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-499-9799
-----------------------------------------------------
Fax | 786-923-8439
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 531 SW 6TH CT OFC 2
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33130-2793
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-499-9799
-----------------------------------------------------
Fax | 786-923-8439
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | RBT-24-383638
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------