Provider Demographics
NPI:1174853022
Name:EIZMENDIZ, SHEENA (CHT, CSMC)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:
Last Name:EIZMENDIZ
Suffix:
Gender:F
Credentials:CHT, CSMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 RED RD STE 129
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5421
Mailing Address - Country:US
Mailing Address - Phone:305-275-0707
Mailing Address - Fax:
Practice Address - Street 1:7600 RED RD STE 129
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5421
Practice Address - Country:US
Practice Address - Phone:305-275-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL408078-4101Y00000X, 103K00000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst