Provider Demographics
NPI:1093577934
Name:MORALES SENJUDO, EILYN ELVIA
Entity Type:Individual
Prefix:
First Name:EILYN
Middle Name:ELVIA
Last Name:MORALES SENJUDO
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 1:19900 GULFSTREAM RD
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8683
Mailing Address - Country:US
Mailing Address - Phone:305-317-8126
Mailing Address - Fax:
Practice Address - Street 1:19900 GULFSTREAM RD
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-8683
Practice Address - Country:US
Practice Address - Phone:305-317-8126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM642-205-85-726-0106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician