Healthcare Provider Details

I. General information

NPI: 1447097829
Provider Name (Legal Business Name): FATEMA ALI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2639 W STATE ROAD 434
LONGWOOD FL
32779-4878
US

IV. Provider business mailing address

2639 W STATE ROAD 434
LONGWOOD FL
32779-4878
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-8326
  • Fax:
Mailing address:
  • Phone: 321-972-8326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: