1538892179 NPI number — DIANA LYNN SANCHEZ REGISTERED BEHAVIOR

Table of content: SYLENA DANIELLE BLANCHARD APRN (NPI 1194442129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538892179 NPI number — DIANA LYNN SANCHEZ REGISTERED BEHAVIOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANCHEZ
Provider First Name:
DIANA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED BEHAVIOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538892179
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4061 NW 66 AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33166-6918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-397-4783
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6625 MIAMI LAKES DRIVE
Provider Second Line Business Practice Location Address:
SUITE 374
Provider Business Practice Location Address City Name:
MIAMI LAKES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33014-2710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-777-3883
Provider Business Practice Location Address Fax Number:
305-777-3837
Provider Enumeration Date:
07/01/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , with the licence number:  RBT-21-18884 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 112551400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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