Provider Demographics
NPI:1336920354
Name:ASCUNCE GOMEZ, SUANLY M
Entity Type:Individual
Prefix:
First Name:SUANLY
Middle Name:M
Last Name:ASCUNCE GOMEZ
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 1:8181 NW S RIVER DR LOT E526
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7482
Mailing Address - Country:US
Mailing Address - Phone:786-326-8627
Mailing Address - Fax:
Practice Address - Street 1:8181 NW S RIVER DR LOT E526
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33166-7482
Practice Address - Country:US
Practice Address - Phone:786-326-8627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-301550103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst