Provider Demographics
NPI:1124017355
Name:ACEVEDO, NILMA (AUD)
Entity Type:Individual
Prefix:MRS
First Name:NILMA
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:AUD
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 7388
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-7388
Mailing Address - Country:US
Mailing Address - Phone:787-265-3190
Mailing Address - Fax:787-265-3190
Practice Address - Street 1:53 CALLE MENDEZ VIGO E
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-5529
Practice Address - Country:US
Practice Address - Phone:787-265-3190
Practice Address - Fax:787-265-3190
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR545231HA2400X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20608Medicare ID - Type Unspecified