Healthcare Provider Details

I. General information

NPI: 1053985952
Provider Name (Legal Business Name): MS. CONSTANCE MAYA BREZDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 08/30/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1172 W OSCEOLA PKWY
KISSIMMEE FL
34741-7515
US

IV. Provider business mailing address

1019 W PEBBLE BEACH CIR
WINTER SPGS FL
32708-4209
US

V. Phone/Fax

Practice location:
  • Phone: 689-204-2221
  • Fax: 689-204-2225
Mailing address:
  • Phone: 407-766-6229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ12167
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: