Provider Demographics
NPI:1164954426
Name:SUAREZ-AVILES, AUDREY STEPHANIE
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:STEPHANIE
Last Name:SUAREZ-AVILES
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 1:2000 N BAYSHORE DR APT 519
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-5120
Mailing Address - Country:US
Mailing Address - Phone:786-340-5830
Mailing Address - Fax:
Practice Address - Street 1:2000 N BAYSHORE DR APT 519
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-5120
Practice Address - Country:US
Practice Address - Phone:786-340-5830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021906900Medicaid