Provider Demographics
NPI:1891347233
Name:NIEVES, LEISHLY MARIE (MS SLP)
Entity Type:Individual
Prefix:
First Name:LEISHLY
Middle Name:MARIE
Last Name:NIEVES
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 1:13A O708 URB ALTURAS DE RIO GRANDE
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:US
Mailing Address - Phone:787-366-5523
Mailing Address - Fax:
Practice Address - Street 1:CARR 167 KM 21.2
Practice Address - Street 2:URB FOREST HILLS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00493
Practice Address - Country:US
Practice Address - Phone:787-999-8262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist