Provider Demographics
NPI:1316386899
Name:SUAREZ, MILENYS
Entity Type:Individual
Prefix:
First Name:MILENYS
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SW 122ND AVE APT 219B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2855
Mailing Address - Country:US
Mailing Address - Phone:786-296-3572
Mailing Address - Fax:
Practice Address - Street 1:1300 SW 122ND AVE APT 219B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-2855
Practice Address - Country:US
Practice Address - Phone:786-556-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
FLRBT-20-117883106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106400900Medicaid