Healthcare Provider Details

I. General information

NPI: 1700365053
Provider Name (Legal Business Name): GRACE JENNY VELEZ PAGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3185 W VINE ST
KISSIMMEE FL
34741-3738
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 407-569-1260
  • Fax: 833-963-0109
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1769
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: