Healthcare Provider Details

I. General information

NPI: 1376152926
Provider Name (Legal Business Name): MARISA MCAVOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S HWY 27 STE B201
CLERMONT FL
34711-6816
US

IV. Provider business mailing address

2400 S HWY 27 STE B201
CLERMONT FL
34711-6816
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-0212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number031362
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA24169
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: