Provider Demographics
NPI:1538892179
Name:SANCHEZ, DIANA LYNN (REGISTERED BEHAVIOR)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:REGISTERED BEHAVIOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4061 NW 66 AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6918
Mailing Address - Country:US
Mailing Address - Phone:786-397-4783
Mailing Address - Fax:
Practice Address - Street 1:6625 MIAMI LAKES DRIVE
Practice Address - Street 2:SUITE 374
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2710
Practice Address - Country:US
Practice Address - Phone:305-777-3883
Practice Address - Fax:305-777-3837
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-18884106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112551400Medicaid