Provider Demographics
NPI:1508872037
Name:LACAYO, NESTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:
Last Name:LACAYO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 NW LAKE WHITNEY PL STE 101
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1618
Mailing Address - Country:US
Mailing Address - Phone:772-344-7228
Mailing Address - Fax:773-344-7158
Practice Address - Street 1:513 NW LAKE WHITNEY PL STE 101
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1618
Practice Address - Country:US
Practice Address - Phone:772-344-7228
Practice Address - Fax:773-344-7158
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42949207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD64743Medicare UPIN
FL94607UMedicare PIN