Healthcare Provider Details

I. General information

NPI: 1053839894
Provider Name (Legal Business Name): MARIEL DALLY RODRIGUEZ-ALEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 11/07/2021
Certification Date: 11/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 S 9TH ST
LEESBURG FL
34748-6320
US

IV. Provider business mailing address

3610 LAZY RIVER TER
SANFORD FL
32771-8403
US

V. Phone/Fax

Practice location:
  • Phone: 407-530-5063
  • Fax:
Mailing address:
  • Phone: 939-640-5798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ9444
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA19672
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: