Provider Demographics
NPI:1053059394
Name:ECHEVARRIA SANTIAGO, SULLYNET
Entity Type:Individual
Prefix:
First Name:SULLYNET
Middle Name:
Last Name:ECHEVARRIA SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1483 ARGO CT
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-5732
Mailing Address - Country:US
Mailing Address - Phone:508-436-0042
Mailing Address - Fax:
Practice Address - Street 1:6 MERIDIAN HOME LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-2402
Practice Address - Country:US
Practice Address - Phone:386-603-4600
Practice Address - Fax:386-243-2940
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician