Provider Demographics
NPI:1104621515
Name:PENA CORRALES, SUNEY HORTENSIA
Entity type:Individual
Prefix:
First Name:SUNEY
Middle Name:HORTENSIA
Last Name:PENA CORRALES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 NW 205TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-1320
Mailing Address - Country:US
Mailing Address - Phone:786-647-4200
Mailing Address - Fax:
Practice Address - Street 1:3100 NW 205TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-1320
Practice Address - Country:US
Practice Address - Phone:786-647-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL105237225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist