Provider Demographics
NPI:1346942174
Name:SUFRALIEN, ENADINE
Entity Type:Individual
Prefix:
First Name:ENADINE
Middle Name:
Last Name:SUFRALIEN
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 1:3360 SPANISH MOSS TER APT 105
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5007
Mailing Address - Country:US
Mailing Address - Phone:954-947-9365
Mailing Address - Fax:
Practice Address - Street 1:3360 SPANISH MOSS TER APT 105
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-5007
Practice Address - Country:US
Practice Address - Phone:954-947-9365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL202303065374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula