Provider Demographics
NPI:1235184029
Name:SARRACINO, LAYDA TERESITA (FMD)
Entity Type:Individual
Prefix:
First Name:LAYDA
Middle Name:TERESITA
Last Name:SARRACINO
Suffix:
Gender:F
Credentials:FMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8785 SW 165TH AVE
Mailing Address - Street 2:202A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5826
Mailing Address - Country:US
Mailing Address - Phone:786-484-7701
Mailing Address - Fax:786-513-2488
Practice Address - Street 1:8785 SW 165TH AVE
Practice Address - Street 2:202A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5826
Practice Address - Country:US
Practice Address - Phone:786-484-7701
Practice Address - Fax:786-513-2488
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL760753900Medicaid