MEDICARE: SULAN SERVICES LLC

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1326606591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SULAN SERVICES LLC

Provider Business Mailing Address
First Line	:	6660 ESTERO BLVD APT B404
Second Line	:
City	:	FORT MYERS BEACH
State	:	FL
Zip	:	33931-4567
Country	:	US
Telephone Number	:	239-628-6999
Fax Number	:

Provider Business Practice Location Address
First Line	:	6660 ESTERO BLVD APT B404
Second Line	:
City	:	FORT MYERS BEACH
State	:	FL
Zip	:	33931-4567
Country	:	US
Telephone Number	:	239-628-6999
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUCEL TEJEDA
Credential	:
Telephone Number	:	239-628-6999

Provider Enumeration Date	:	06/03/2019
Last Update Date	:	08/01/2022

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