MEDICARE: NEETU PERSAD-TAPIA RMFTI

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	106H00000X	Marriage & Family Therapist	IMT3309	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IMT3309	OTHER	FL	STATE OF FLORIDA

General Provider Information

NPI Number	:	1275286072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEETU PERSAD-TAPIA RMFTI

Provider Business Mailing Address
First Line	:	1035 S SEMORAN BLVD STE 1049
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-5512
Country	:	US
Telephone Number	:	321-972-1875
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 S SEMORAN BLVD STE 1049
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-5512
Country	:	US
Telephone Number	:	321-972-1875
Fax Number	:

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

Provider Enumeration Date	:	02/01/2022
Last Update Date	:	02/01/2022

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