Provider Demographics
NPI:1083784904
Name:FELICIANO, BRISEIDA ENID (MD)
Entity Type:Individual
Prefix:DR
First Name:BRISEIDA
Middle Name:ENID
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8818
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-8818
Mailing Address - Country:US
Mailing Address - Phone:178-770-3392
Mailing Address - Fax:178-770-3390
Practice Address - Street 1:V28 AVE LUIS MUNOZ MARIN
Practice Address - Street 2:URB. MARIOLGA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6462
Practice Address - Country:US
Practice Address - Phone:178-770-3392
Practice Address - Fax:178-770-3390
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR95252084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR069484OtherCRUZ AZUL
PR82821FEOtherTRIPLE S
PA217031OtherPREFERRED HEALTH
PR069484OtherCRUZ AZUL
PR82821FEOtherTRIPLE S