Provider Demographics
NPI:1710026570
Name:NIEVES, VANESSA (DPM)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:NIEVES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 CURRY FORD RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2939
Mailing Address - Country:US
Mailing Address - Phone:407-737-1518
Mailing Address - Fax:407-737-1198
Practice Address - Street 1:5767 CURRY FORD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2939
Practice Address - Country:US
Practice Address - Phone:407-737-1518
Practice Address - Fax:407-737-1198
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2586213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65469Medicare ID - Type UnspecifiedMEDICARE ID
FLU64375Medicare UPIN
1313750001Medicare NSC