Provider Demographics
NPI:1396571725
Name:BRACELIS, JOSIAS LIMA
Entity type:Individual
Prefix:
First Name:JOSIAS
Middle Name:LIMA
Last Name:BRACELIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 PUTNAM AVE APT 1AR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-0647
Mailing Address - Country:US
Mailing Address - Phone:786-263-1297
Mailing Address - Fax:
Practice Address - Street 1:1504 MACOMBS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-2142
Practice Address - Country:US
Practice Address - Phone:786-263-1297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist