Provider Demographics
NPI:1225757107
Name:SANCHEZ VAZQUEZ, HEIDY
Entity Type:Individual
Prefix:
First Name:HEIDY
Middle Name:
Last Name:SANCHEZ VAZQUEZ
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 1:11120 SW 196TH ST
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8309
Mailing Address - Country:US
Mailing Address - Phone:786-818-6577
Mailing Address - Fax:
Practice Address - Street 1:11120 SW 196TH ST
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-8309
Practice Address - Country:US
Practice Address - Phone:786-818-6577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-225436106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS522-320-01-919-0Medicaid