Healthcare Provider Details

I. General information

NPI: 1659473049
Provider Name (Legal Business Name): KATIA QUEVEDO PY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 NW 77TH AVE STE 310
MIAMI FL
33166-2846
US

IV. Provider business mailing address

13205 NW 7TH LN
MIAMI FL
33182-2282
US

V. Phone/Fax

Practice location:
  • Phone: 786-558-5637
  • Fax: 786-558-4188
Mailing address:
  • Phone: 305-798-7317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY11260
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: