Provider Demographics
NPI:1174093892
Name:RIVERA, SUELY G (MS)
Entity type:Individual
Prefix:MRS
First Name:SUELY
Middle Name:G
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11885 FICTION AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5120
Mailing Address - Country:US
Mailing Address - Phone:321-465-2271
Mailing Address - Fax:
Practice Address - Street 1:7157 NARCOOSSEE RD # 1016
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5533
Practice Address - Country:US
Practice Address - Phone:321-878-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18992101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health