Healthcare Provider Details

I. General information

NPI: 1417555970
Provider Name (Legal Business Name): NINOSHKA VELEZ PEREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 PLAZA DR
KISSIMMEE FL
34743-4064
US

IV. Provider business mailing address

6675 WESTWOOD BLVD STE 475
ORLANDO FL
32821-6027
US

V. Phone/Fax

Practice location:
  • Phone: 407-350-5659
  • Fax: 407-350-5662
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: