MEDICARE: MAYRA SOTERO BCBA

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	1-25-86202	FL

General Provider Information

NPI Number	:	1982566501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYRA SOTERO BCBA

Provider Business Mailing Address
First Line	:	2254 SW HAYCRAFT CIR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-2707
Country	:	US
Telephone Number	:	772-807-1363
Fax Number	:

Provider Business Practice Location Address
First Line	:	1973 SW SAVAGE BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-2791
Country	:	US
Telephone Number	:	772-203-6496
Fax Number	:

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

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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Directions to “ MAYRA SOTERO BCBA” Practice Location

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