Healthcare Provider Details

I. General information

NPI: 1366366973
Provider Name (Legal Business Name): MR. CARMELO NIEVES-COLON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #2 KM 23.8
DORADO PR
00646
US

IV. Provider business mailing address

HC 3 BOX 8726
DORADO PR
00646-9589
US

V. Phone/Fax

Practice location:
  • Phone: 787-615-5388
  • Fax:
Mailing address:
  • Phone: 787-615-5388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4274
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: