Healthcare Provider Details

I. General information

NPI: 1982566170
Provider Name (Legal Business Name): LEILANIE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 W BASS ST
KISSIMMEE FL
34741-5001
US

IV. Provider business mailing address

11903 GREAT COMMISSION WAY FL USA
ORLANDO FL
32832-7052
US

V. Phone/Fax

Practice location:
  • Phone: 321-445-1287
  • Fax:
Mailing address:
  • Phone: 407-284-2779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI8415
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: