Provider Demographics
NPI:1548744121
Name:ABREU, BLYE NICOLE
Entity Type:Individual
Prefix:
First Name:BLYE
Middle Name:NICOLE
Last Name:ABREU
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 1:8001 SW 36TH ST STE 9
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-1915
Mailing Address - Country:US
Mailing Address - Phone:954-577-7790
Mailing Address - Fax:954-577-7780
Practice Address - Street 1:8001 SW 36TH ST STE 9
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-1915
Practice Address - Country:US
Practice Address - Phone:954-577-7790
Practice Address - Fax:954-577-7780
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician