Provider Demographics
NPI:1245021740
Name:PEDRAZA GARZON, SANDRAMILENA
Entity type:Individual
Prefix:
First Name:SANDRAMILENA
Middle Name:
Last Name:PEDRAZA GARZON
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 1:6416 NW 102ND CT APT 106
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3093
Mailing Address - Country:US
Mailing Address - Phone:305-849-3723
Mailing Address - Fax:
Practice Address - Street 1:6416 NW 102ND CT APT 106
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-3093
Practice Address - Country:US
Practice Address - Phone:305-849-3723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician