MEDICARE: KERRIANN DE MARIA B.S., L-SLPA

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	2355S0801X	Speech-Language Assistant	SI5904	FL

General Provider Information

NPI Number	:	1902672520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRIANN DE MARIA B.S., L-SLPA

Provider Business Mailing Address
First Line	:	9703 AVELLINO AVE UNIT 1424
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-8817
Country	:	US
Telephone Number	:	561-818-8117
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 S WEST CROWN POINT RD STE 150
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-2917
Country	:	US
Telephone Number	:	407-905-8908
Fax Number	:

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

Provider Enumeration Date	:	11/27/2023
Last Update Date	:	11/27/2023

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