Healthcare Provider Details

I. General information

NPI: 1225844335
Provider Name (Legal Business Name): MICHELLE DENISE CUADRADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 N MAIN ST
KISSIMMEE FL
34744-4564
US

IV. Provider business mailing address

339 CLERMONT DR
KISSIMMEE FL
34759-3454
US

V. Phone/Fax

Practice location:
  • Phone: 407-930-1000
  • Fax:
Mailing address:
  • Phone: 407-393-8305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: