Provider Demographics
NPI:1518712306
Name:SAAVEDRA PENA, SHEYLA THALIA
Entity Type:Individual
Prefix:
First Name:SHEYLA
Middle Name:THALIA
Last Name:SAAVEDRA PENA
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 1:4100 SW 110TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4746
Mailing Address - Country:US
Mailing Address - Phone:308-371-7286
Mailing Address - Fax:
Practice Address - Street 1:4100 SW 110TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4746
Practice Address - Country:US
Practice Address - Phone:308-371-7286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-341309106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician