Healthcare Provider Details

I. General information

NPI: 1962347880
Provider Name (Legal Business Name): DIALMARYS VELEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 BLACKBERRY LN
AUGUSTA GA
30906-9735
US

IV. Provider business mailing address

157 BLACKBERRY LN
AUGUSTA GA
30906-9735
US

V. Phone/Fax

Practice location:
  • Phone: 706-751-5369
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: