Provider Demographics
NPI:1508402868
Name:MERCADO NERIS, KIARA DALISSE (MS-SLP)
Entity Type:Individual
Prefix:
First Name:KIARA
Middle Name:DALISSE
Last Name:MERCADO NERIS
Suffix:
Gender:F
Credentials:MS-SLP
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 439
Mailing Address - Street 2:
Mailing Address - City:VIEQUES
Mailing Address - State:PR
Mailing Address - Zip Code:00765-0439
Mailing Address - Country:US
Mailing Address - Phone:787-955-0969
Mailing Address - Fax:
Practice Address - Street 1:CALLE CORAL #101 BARRIO FLORIDA
Practice Address - Street 2:
Practice Address - City:VIEQUES
Practice Address - State:PR
Practice Address - Zip Code:00765
Practice Address - Country:US
Practice Address - Phone:787-955-0969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4149235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist