Healthcare Provider Details

I. General information

NPI: 1215850425
Provider Name (Legal Business Name): JEYSAMAR VELEZ SANTIAGO DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13670 BOGGY CREEK RD STE 100
ORLANDO FL
32824-9235
US

IV. Provider business mailing address

353 WINDY WILLOW WAY
SAINT CLOUD FL
34771-8157
US

V. Phone/Fax

Practice location:
  • Phone: 407-729-3191
  • Fax:
Mailing address:
  • Phone: 407-729-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH16058
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: