Healthcare Provider Details

I. General information

NPI: 1780549261
Provider Name (Legal Business Name): YARISSE VELEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 WADEVIEW LOOP
SAINT CLOUD FL
34769-6529
US

IV. Provider business mailing address

2521 WADEVIEW LOOP
SAINT CLOUD FL
34769-6529
US

V. Phone/Fax

Practice location:
  • Phone: 689-262-0689
  • Fax:
Mailing address:
  • Phone: 689-262-0689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDO7430
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: