Provider Demographics
NPI:1558522953
Name:HERNANDEZ, NEYSI
Entity Type:Individual
Prefix:DR
First Name:NEYSI
Middle Name:
Last Name:HERNANDEZ
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 1:12900 SW 82ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4302
Mailing Address - Country:US
Mailing Address - Phone:786-266-0681
Mailing Address - Fax:
Practice Address - Street 1:925 NE 30TH TER
Practice Address - Street 2:SUITE 104
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7613
Practice Address - Country:US
Practice Address - Phone:305-508-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 18293122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist