Provider Demographics
NPI:1275193310
Name:GUTIERREZ SILVA, NADIESHA
Entity Type:Individual
Prefix:
First Name:NADIESHA
Middle Name:
Last Name:GUTIERREZ SILVA
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 1:28085 SW 137TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5745
Mailing Address - Country:US
Mailing Address - Phone:786-557-4616
Mailing Address - Fax:
Practice Address - Street 1:28085 SW 137TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-5745
Practice Address - Country:US
Practice Address - Phone:786-557-4616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-19-80464106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician