Provider Demographics
NPI:1366077455
Name:VELEZ SALAS, STEPHANY VYANN
Entity type:Individual
Prefix:DR
First Name:STEPHANY
Middle Name:VYANN
Last Name:VELEZ SALAS
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 1:105 CALLE CAOBA
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-3937
Mailing Address - Country:US
Mailing Address - Phone:787-806-7144
Mailing Address - Fax:
Practice Address - Street 1:300 AVE NOEL ESTRADA
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3275
Practice Address - Country:US
Practice Address - Phone:787-669-3815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6594103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical