Provider Demographics
NPI:1225380496
Name:QUEVEDO, ODALYS SANTOS
Entity type:Individual
Prefix:MRS
First Name:ODALYS
Middle Name:SANTOS
Last Name:QUEVEDO
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 1:5801 SW 74TH TER APT 5
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5265
Mailing Address - Country:US
Mailing Address - Phone:786-546-4324
Mailing Address - Fax:
Practice Address - Street 1:4343 W FLAGLER ST, SUITE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-774-9570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor