Provider Demographics
NPI:1245698216
Name:NUNEZ OTERO, SYLVIA DOLORES (LMT)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:DOLORES
Last Name:NUNEZ OTERO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12027 ROYAL PALM BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3300
Mailing Address - Country:US
Mailing Address - Phone:954-857-4851
Mailing Address - Fax:
Practice Address - Street 1:13224 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33325-2228
Practice Address - Country:US
Practice Address - Phone:954-400-5504
Practice Address - Fax:954-400-5503
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA76356225700000X
FLCNA 187366376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA76356OtherLICENSED MASSAGE THERAPIST