Provider Demographics
NPI:1457036402
Name:SUPRIUS, WEETHIANA
Entity Type:Individual
Prefix:
First Name:WEETHIANA
Middle Name:
Last Name:SUPRIUS
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 1:6880 OSBORNE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-3854
Mailing Address - Country:US
Mailing Address - Phone:561-831-8786
Mailing Address - Fax:
Practice Address - Street 1:13136 88TH PL N
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33412-2627
Practice Address - Country:US
Practice Address - Phone:877-857-8517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician