MEDICARE: ANTAINETTE EWART

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	6109	FL
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1952816852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTAINETTE EWART

Provider Business Mailing Address
First Line	:	6173 RALEIGH ST APT 1704
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-2296
Country	:	US
Telephone Number	:	407-272-1984
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 PARK CENTER DR STE 230
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-6235
Country	:	US
Telephone Number	:	321-445-1287
Fax Number	:

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

Provider Enumeration Date	:	12/13/2017
Last Update Date	:	12/08/2023

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Directions to “ ANTAINETTE EWART ” Practice Location

Language	Start Address	Practice Location

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