MEDICARE: SUSANA SARA CACERES

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	1-21-52621	NC

General Provider Information

NPI Number	:	1427543099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANA SARA CACERES

Provider Business Mailing Address
First Line	:	7108 S KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7462
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Provider Business Practice Location Address
First Line	:	17119 RED FEATHER DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-2991
Country	:	US
Telephone Number	:	786-398-1649
Fax Number	:

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

Provider Enumeration Date	:	06/26/2018
Last Update Date	:	11/29/2022

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Directions to “ SUSANA SARA CACERES ” Practice Location

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