Provider Demographics
NPI:1508344755
Name:BARREIRO SARDUY, MAYLEN
Entity Type:Individual
Prefix:
First Name:MAYLEN
Middle Name:
Last Name:BARREIRO SARDUY
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 1:1217 STONEWAY LN
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-5664
Mailing Address - Country:US
Mailing Address - Phone:561-729-6631
Mailing Address - Fax:
Practice Address - Street 1:2682 W 74TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5431
Practice Address - Country:US
Practice Address - Phone:561-729-6631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15-11238106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician