Healthcare Provider Details

I. General information

NPI: 1588414767
Provider Name (Legal Business Name): VIELKA NUNEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 PENNSYLVANIA AVE
SAINT CLOUD FL
34769-2885
US

IV. Provider business mailing address

3201 BUDINGER AVE
SAINT CLOUD FL
34769-7203
US

V. Phone/Fax

Practice location:
  • Phone: 347-792-9109
  • Fax:
Mailing address:
  • Phone: 407-498-4079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-335185
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: