Healthcare Provider Details

I. General information

NPI: 1689583874
Provider Name (Legal Business Name): MS. THAIS PEDROSA RIBEIRO DE OLIVEIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9421 BUD WOOD ST
GOTHA FL
34734-5032
US

IV. Provider business mailing address

9421 BUD WOOD ST
GOTHA FL
34734-5032
US

V. Phone/Fax

Practice location:
  • Phone: 321-429-4553
  • Fax:
Mailing address:
  • Phone: 321-429-4553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: