Provider Demographics
NPI:1275131641
Name:NIEVES, KAYLEE SOFIA (LMT)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:SOFIA
Last Name:NIEVES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 NE 53RD ST APT 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2839
Mailing Address - Country:US
Mailing Address - Phone:407-967-1625
Mailing Address - Fax:
Practice Address - Street 1:265 NE 53RD ST APT 3
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2839
Practice Address - Country:US
Practice Address - Phone:407-967-1625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA95906225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN120517979080OtherDL