MEDICARE: SHIRLEY JOHANNA SANCHEZ

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	106S00000X	Behavior Technician	RBT-24-327794	FL

General Provider Information

NPI Number	:	1851157291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY JOHANNA SANCHEZ

Provider Business Mailing Address
First Line	:	4550 NW 197TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-1828
Country	:	US
Telephone Number	:	786-838-3250
Fax Number	:

Provider Business Practice Location Address
First Line	:	4550 NW 197TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-1828
Country	:	US
Telephone Number	:	786-838-3250
Fax Number	:

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

Provider Enumeration Date	:	02/23/2024
Last Update Date	:	02/23/2024

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