Provider Demographics
NPI:1881242311
Name:NIEVES DOMINGUEZ, YAXIRY VERONICA
Entity type:Individual
Prefix:
First Name:YAXIRY
Middle Name:VERONICA
Last Name:NIEVES DOMINGUEZ
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 1:2853 BAINBRIDGE AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-2801
Mailing Address - Country:US
Mailing Address - Phone:347-617-2139
Mailing Address - Fax:
Practice Address - Street 1:1925 BATHGATE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-4404
Practice Address - Country:US
Practice Address - Phone:718-468-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program