MEDICARE: MITZA EIMY NIEVES M.S, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1891257978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITZA EIMY NIEVES M.S, CCC-SLP

Provider Business Mailing Address
First Line	:	769 STERLING SPRING RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-6664
Country	:	US
Telephone Number	:	407-307-5416
Fax Number	:

Provider Business Practice Location Address
First Line	:	769 STERLING SPRING RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-6664
Country	:	US
Telephone Number	:	407-307-5416
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2019
Last Update Date	:	04/05/2019

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