Healthcare Provider Details

I. General information

NPI: 1306681044
Provider Name (Legal Business Name): ALICIA S NIEVES IBCLC, CBC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9725 SELTEN WAY UNIT C
ORLANDO FL
32827-7933
US

IV. Provider business mailing address

1677 DUNLAP DR
DELTONA FL
32725-4821
US

V. Phone/Fax

Practice location:
  • Phone: 860-933-8629
  • Fax:
Mailing address:
  • Phone: 860-933-8629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: