Basic Information
| Provider Information | |||||||||
| NPI: | 1245716653 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIEVES | ||||||||
| FirstName: | ALEXIS | ||||||||
| MiddleName: | JA'NEI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1505 RINGMORE CT | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335274961 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 W BROADWAY ST STE 214 | ||||||||
| Address2: | |||||||||
| City: | OVIEDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327659262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073595693 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2018 | ||||||||
| LastUpdateDate: | 09/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2355S0801X | SI3711 | FL | N | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | 252Y00000X | Y | Agencies | Early Intervention Provider Agency |
No ID Information.