Healthcare Provider Details

I. General information

NPI: 1023838356
Provider Name (Legal Business Name): MIKAYLA ELIZABETH RYDER-WEBBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 WAYMONT CT STE 101
LAKE MARY FL
32746-3566
US

IV. Provider business mailing address

55 W CHURCH ST APT 1608
ORLANDO FL
32801-4916
US

V. Phone/Fax

Practice location:
  • Phone: 954-850-1920
  • Fax:
Mailing address:
  • Phone: 985-346-2713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: