Provider Demographics
NPI:1689499808
Name:RODRIGUEZ VEGA, NEDELSY
Entity type:Individual
Prefix:
First Name:NEDELSY
Middle Name:
Last Name:RODRIGUEZ VEGA
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 1:6237 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-5213
Mailing Address - Country:US
Mailing Address - Phone:305-391-8576
Mailing Address - Fax:
Practice Address - Street 1:6237 9TH AVE
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-5213
Practice Address - Country:US
Practice Address - Phone:305-391-8576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-394410106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician