Provider Demographics
NPI:1275038036
Name:NIEVES ANDRADES, ENID YADIRA
Entity Type:Individual
Prefix:
First Name:ENID
Middle Name:YADIRA
Last Name:NIEVES ANDRADES
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 1:5064 BRILLIANCE CIR
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-2493
Mailing Address - Country:US
Mailing Address - Phone:787-806-7242
Mailing Address - Fax:
Practice Address - Street 1:1887 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5530
Practice Address - Country:US
Practice Address - Phone:771-463-0444
Practice Address - Fax:772-219-1339
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician