Provider Demographics
NPI:1588048599
Name:MARTINEZ, SULAY MILAGROS (MA)
Entity type:Individual
Prefix:
First Name:SULAY
Middle Name:MILAGROS
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SULAY
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1112 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5310
Mailing Address - Country:US
Mailing Address - Phone:407-790-5272
Mailing Address - Fax:407-344-2749
Practice Address - Street 1:1112 MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5310
Practice Address - Country:US
Practice Address - Phone:407-790-5272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-20
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-19-37185103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst