Healthcare Provider Details

I. General information

NPI: 1073432803
Provider Name (Legal Business Name): SAIDEL HERNANDEZ VAZQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E MERRITT ISLAND CSWY STE 105
MERRITT ISLAND FL
32952-3514
US

IV. Provider business mailing address

1412 GRAVES ST SE
PALM BAY FL
32909-6436
US

V. Phone/Fax

Practice location:
  • Phone: 321-453-8882
  • Fax:
Mailing address:
  • Phone: 585-719-7063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN32222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: