MEDICARE: LAQUANDRA FRAZIER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063813012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAQUANDRA FRAZIER

Provider Business Mailing Address
First Line	:	175 MIDDLE ST
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17335 PAGONIA DR
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-6011
Country	:	US
Telephone Number	:	352-614-4299
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2014
Last Update Date	:	05/31/2017

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Directions to “ LAQUANDRA FRAZIER ” Practice Location

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