Sully Diaz Cruz

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

3501 W Vine St Ste 124
Kissimmee, FL 34741-4660

Phone

(407) 483-3074

NPI assigned

Jan 18, 2024

Last updated

Jan 18, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• A Boundless Care Inc

  • Community/Behavioral Health Agency
  • Kissimmee, FL
  • NPI 1235527789
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1558122374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11826 DEER PATH WAY",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328327047",
            "telephone_number": "787-507-7756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 W VINE ST STE 124",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347414660",
            "telephone_number": "407-483-3074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ CRUZ",
        "first_name": "SULLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-18",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diamond Peak Emergency Physicians LLC
• Adam Diamond, DPT, ATC, CSCS
• Nicole Mariette Diaz Almodovar, MSW
• Yanelys Caridad Diaz Capote, YD
• Mariangelis Diaz Cruz
• Mayelin Diaz Cuba, FNP-C
• Luis Alfredo Diaz Estremera
• Susana Diaz Fadraga
• Liz Barbara Diaz Ferrer
• Aimee Diaz Fontanez

• Behavior Technician in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Behavior Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.