Provider Demographics
NPI:1548090152
Name:AYALA CALDERO, NELLYANN (BA, PMB, CFM, RN)
Entity type:Individual
Prefix:
First Name:NELLYANN
Middle Name:
Last Name:AYALA CALDERO
Suffix:
Gender:F
Credentials:BA, PMB, CFM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PARQUE DEL MONTE CALLE CAGUAX EE-30
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-526-5557
Mailing Address - Fax:
Practice Address - Street 1:AVE. DEGETAU BONNEVILLE HEIGHTS #4 CALLE LAS PIEDRAS W1
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-526-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACFM03114224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Single Specialty