Provider Demographics
NPI:1508913526
Name:SUAREZ, MILDRED (MS, CCC)
Entity Type:Individual
Prefix:MS
First Name:MILDRED
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:MS
Other - First Name:MILLIE
Other - Middle Name:MARTINEZ
Other - Last Name:SUAREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC
Mailing Address - Street 1:8510 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4053
Mailing Address - Country:US
Mailing Address - Phone:305-266-5353
Mailing Address - Fax:305-266-6550
Practice Address - Street 1:8510 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4053
Practice Address - Country:US
Practice Address - Phone:305-266-5353
Practice Address - Fax:305-266-6550
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 1502235Z00000X
FLSA1502261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL237488OtherAMERIGROUP
FL65-0303523OtherSOUTH CARE PPO
FL65-0303523OtherVISTA HEALTH PLAN
FL880762101Medicaid
FL4602011OtherUNITED HEALTH CARE
FLS0638OtherBCBS BILLING NUMBER
FL65-0303523OtherHUMANA
FL38616OtherNHP PROVIDER NUMBER
FL880762100Medicaid
FL102170OtherAV-MED
FL2692772-001OtherCIGNA HEALTH CARE