Provider Demographics
NPI:1881437432
Name:PENTON QUEVEDO, SILVANA
Entity type:Individual
Prefix:
First Name:SILVANA
Middle Name:
Last Name:PENTON QUEVEDO
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 1:8871 FONTAINEBLEAU BLVD APT 508
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4468
Mailing Address - Country:US
Mailing Address - Phone:786-319-6320
Mailing Address - Fax:
Practice Address - Street 1:8871 FONTAINEBLEAU BLVD APT 508
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4468
Practice Address - Country:US
Practice Address - Phone:786-319-6320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-351565106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty