Provider Demographics
NPI:1649032061
Name:VALDIVIESO-HERNANDEZ, KEYSHALEE (DC)
Entity type:Individual
Prefix:
First Name:KEYSHALEE
Middle Name:
Last Name:VALDIVIESO-HERNANDEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 6261
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784-3517
Mailing Address - Country:US
Mailing Address - Phone:787-941-0665
Mailing Address - Fax:
Practice Address - Street 1:9726 LAKE DISTRICT LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5830
Practice Address - Country:US
Practice Address - Phone:787-941-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14924111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor