Healthcare Provider Details

I. General information

NPI: 1750294500
Provider Name (Legal Business Name): ANDREA FERNANDA MARCANO RIVERA SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 CITRUS TOWER BLVD STE D
CLERMONT FL
34711-6880
US

IV. Provider business mailing address

3115 CITRUS TOWER BLVD STE D
CLERMONT FL
34711-6880
US

V. Phone/Fax

Practice location:
  • Phone: 407-374-8010
  • Fax:
Mailing address:
  • Phone: 407-374-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA25035
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: