Provider Demographics
NPI:1659980993
Name:SUAREZ SURIS, YENEDY
Entity Type:Individual
Prefix:
First Name:YENEDY
Middle Name:
Last Name:SUAREZ SURIS
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 1:575 W 51ST PL APT 11
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3627
Mailing Address - Country:US
Mailing Address - Phone:561-921-7335
Mailing Address - Fax:
Practice Address - Street 1:575 W 51ST PL APT 11
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3627
Practice Address - Country:US
Practice Address - Phone:561-921-7335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-128328106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician