Provider Demographics
NPI:1649356957
Name:VILLANUEVA, MARIE-CLAIRE D (DPM)
Entity type:Individual
Prefix:
First Name:MARIE-CLAIRE
Middle Name:D
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 SYKES LOOP DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3074
Mailing Address - Country:US
Mailing Address - Phone:321-213-0249
Mailing Address - Fax:866-590-7237
Practice Address - Street 1:227 SYKES LOOP DR
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3074
Practice Address - Country:US
Practice Address - Phone:321-213-0249
Practice Address - Fax:866-590-7237
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2657213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390453900Medicaid
FLU64648Medicare UPIN
FL390453900Medicaid
FL4494490001Medicare NSC