Healthcare Provider Details

I. General information

NPI: 1962333062
Provider Name (Legal Business Name): JENNIFER QUEVEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

861 SE 1ST PL
HIALEAH FL
33010-5504
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-5722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835I0206X
TaxonomyInfectious Diseases Pharmacist
License NumberPS53996
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: