Healthcare Provider Details

I. General information

NPI: 1780338160
Provider Name (Legal Business Name): MIKERLANDE GEDEUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 ROCK SPRINGS RD STE 354
APOPKA FL
32712-2229
US

IV. Provider business mailing address

1631 ROCK SPRINGS RD STE 354
APOPKA FL
32712-2229
US

V. Phone/Fax

Practice location:
  • Phone: 191-222-0613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberSS1603
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1603
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: