Provider Demographics
NPI:1154628063
Name:SERRANO, NYDIA (DPM)
Entity Type:Individual
Prefix:DR
First Name:NYDIA
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7647 TERN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-7669
Mailing Address - Country:US
Mailing Address - Phone:407-658-9553
Mailing Address - Fax:
Practice Address - Street 1:7647 TERN DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-7669
Practice Address - Country:US
Practice Address - Phone:407-658-9553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-12
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2973213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine