Healthcare Provider Details

I. General information

NPI: 1386348019
Provider Name (Legal Business Name): NYLA NAEEM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1397 MEDICAL PARK BLVD STE 220
WELLINGTON FL
33414-3187
US

IV. Provider business mailing address

1397 MEDICAL PARK BLVD STE 220
WELLINGTON FL
33414-3187
US

V. Phone/Fax

Practice location:
  • Phone: 561-652-8656
  • Fax:
Mailing address:
  • Phone: 561-652-8656
  • Fax: 561-652-8657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS23968
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: