Provider Demographics
NPI:1184279408
Name:QUEVEDO TORRES, NELIDA ALICIA
Entity type:Individual
Prefix:
First Name:NELIDA
Middle Name:ALICIA
Last Name:QUEVEDO TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 SW 153RD PL N
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4109
Mailing Address - Country:US
Mailing Address - Phone:786-803-1353
Mailing Address - Fax:
Practice Address - Street 1:5201 SW 153RD PL N
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4109
Practice Address - Country:US
Practice Address - Phone:786-803-1353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-04
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-25-16128106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017987900Medicaid