Healthcare Provider Details

I. General information

NPI: 1962369405
Provider Name (Legal Business Name): NAYELIS PELLOT CORCHADO SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE JUAN SAN ANTONIO,BO PUEBLO.
MOCA PR
00676
US

IV. Provider business mailing address

URB. MANUEL CORCHADO CALLE GARDENIA #59
ISABELA PR
00662
US

V. Phone/Fax

Practice location:
  • Phone: 787-818-0100
  • Fax: 787-877-4513
Mailing address:
  • Phone: 939-406-7060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number008028
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: