Healthcare Provider Details

I. General information

NPI: 1558086520
Provider Name (Legal Business Name): HAYLEI SUMMER RIEDEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 S SUN DR STE 1089
LAKE MARY FL
32746-6169
US

IV. Provider business mailing address

1468 NORTHRIDGE DR
LONGWOOD FL
32750-4548
US

V. Phone/Fax

Practice location:
  • Phone: 407-323-6955
  • Fax:
Mailing address:
  • Phone: 407-925-9491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13152
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: