Healthcare Provider Details

I. General information

NPI: 1588239115
Provider Name (Legal Business Name): GLIEDMAR CUEVAS CARDEL SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EMMETT ST STE 102
KISSIMMEE FL
34741-3605
US

IV. Provider business mailing address

4823 CROSS PRAIRIE PKWY
SAINT CLOUD FL
34772-6304
US

V. Phone/Fax

Practice location:
  • Phone: 407-913-1010
  • Fax:
Mailing address:
  • Phone: 787-503-8286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number3604
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI4862
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: