Provider Demographics
NPI:1114587409
Name:SAULEDA SIERRA, SUNIELKYS
Entity Type:Individual
Prefix:
First Name:SUNIELKYS
Middle Name:
Last Name:SAULEDA SIERRA
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 1:19092 NW 12TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2958
Mailing Address - Country:US
Mailing Address - Phone:786-428-7712
Mailing Address - Fax:
Practice Address - Street 1:19092 NW 12TH CT
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2958
Practice Address - Country:US
Practice Address - Phone:786-428-7712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-21-50707103K00000X
FL0-20-10865106E00000X
FLRBT-18-69065106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103299900Medicaid