Healthcare Provider Details

I. General information

NPI: 1962120246
Provider Name (Legal Business Name): YLLEN MARIE ROSA CORIANO SLPA,RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 GULF STREAM CIR APT 202
BRANDON FL
33511-2848
US

IV. Provider business mailing address

1405 GULF STREAM CIR APT 202
BRANDON FL
33511-2848
US

V. Phone/Fax

Practice location:
  • Phone: 656-233-7283
  • Fax:
Mailing address:
  • Phone: 656-233-7383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI8530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: