Provider Demographics
NPI:1376251983
Name:SOTOMAYOR CUADRADO, ANNHALYE O
Entity type:Individual
Prefix:
First Name:ANNHALYE
Middle Name:O
Last Name:SOTOMAYOR CUADRADO
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 1:454 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3349
Mailing Address - Country:US
Mailing Address - Phone:786-281-9139
Mailing Address - Fax:
Practice Address - Street 1:454 E 33RD ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3349
Practice Address - Country:US
Practice Address - Phone:786-281-9139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB-819129106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBACB-819129OtherBACB-819129