Provider Demographics
NPI:1831572932
Name:NIEVES, IRINA (MSSPED)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:NIEVES
Suffix:
Gender:F
Credentials:MSSPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1014
Mailing Address - Country:US
Mailing Address - Phone:347-761-4523
Mailing Address - Fax:
Practice Address - Street 1:16 SCOTT DR
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-1014
Practice Address - Country:US
Practice Address - Phone:347-761-4523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2617843174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist