MEDICARE: ROSA SEQUEIROS S.S.P., N.C.S.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	SS1089	FL
2	103T00000X	Psychologist	SS1089	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205421120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA SEQUEIROS S.S.P., N.C.S.P.

Provider Business Mailing Address
First Line	:	15192 SW 137TH ST STE 13
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-5786
Country	:	US
Telephone Number	:	786-529-8378
Fax Number	:

Provider Business Practice Location Address
First Line	:	7001 SW 97TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-1406
Country	:	US
Telephone Number	:	786-529-8378
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	12/20/2024

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Directions to “ ROSA SEQUEIROS S.S.P., N.C.S.P.” Practice Location

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