Healthcare Provider Details

I. General information

NPI: 1629932595
Provider Name (Legal Business Name): CONSUELLA NIEVES
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 E HWY 290 STE 300
AUSTIN TX
78723-1174
US

IV. Provider business mailing address

6400 E HWY 290 STE 300
AUSTIN TX
78723-1174
US

V. Phone/Fax

Practice location:
  • Phone: 240-342-2666
  • Fax:
Mailing address:
  • Phone: 240-342-2666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: