Provider Demographics
NPI:1427459825
Name:WALKER, SUAVE R (MS)
Entity type:Individual
Prefix:MR
First Name:SUAVE R
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 SW 101ST TER APT 307
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5047
Mailing Address - Country:US
Mailing Address - Phone:786-663-4389
Mailing Address - Fax:
Practice Address - Street 1:15100 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-2642
Practice Address - Country:US
Practice Address - Phone:305-685-8201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT 1983106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist