Provider Demographics
NPI:1326861337
Name:FEQUIERE, SIBILE
Entity type:Individual
Prefix:
First Name:SIBILE
Middle Name:
Last Name:FEQUIERE
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 1:5611 CENTURY 21 BLVD APT 192
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-2237
Mailing Address - Country:US
Mailing Address - Phone:347-500-1014
Mailing Address - Fax:
Practice Address - Street 1:6973 UNIVERSITY BLVD # 1308
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-6713
Practice Address - Country:US
Practice Address - Phone:347-500-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF26078082874-0106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty