Healthcare Provider Details

I. General information

NPI: 1265258917
Provider Name (Legal Business Name): GIOVANNA CENTENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
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

962 BENTSTATION LN APT 346
LAKE MARY FL
32746-2278
US

V. Phone/Fax

Practice location:
  • Phone: 407-323-6955
  • Fax:
Mailing address:
  • Phone: 407-687-6372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number6083
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ12476
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA24860
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: