Healthcare Provider Details

I. General information

NPI: 1659280956
Provider Name (Legal Business Name): NYDMARI LAUREANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BURNS AVE
LAKE WALES FL
33853-3335
US

IV. Provider business mailing address

9305 TECUMSEH DR
ORLANDO FL
32825-3839
US

V. Phone/Fax

Practice location:
  • Phone: 407-388-4010
  • Fax:
Mailing address:
  • Phone: 407-388-4010
  • Fax: 855-382-0727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI3846
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: