Healthcare Provider Details

I. General information

NPI: 1366330904
Provider Name (Legal Business Name): NYAH NEVILLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 S MATANZAS AVE
TAMPA FL
33609-3010
US

IV. Provider business mailing address

217 S MATANZAS AVE
TAMPA FL
33609-3010
US

V. Phone/Fax

Practice location:
  • Phone: 813-254-0482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: