Healthcare Provider Details

I. General information

NPI: 1437156502
Provider Name (Legal Business Name): JENNY THERESA VELEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5018 DR PHILLIPS BLVD
ORLANDO FL
32819-3310
US

IV. Provider business mailing address

PO BOX 191
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 407-363-5753
  • Fax: 407-351-4121
Mailing address:
  • Phone: 302-651-4488
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME69983
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: