Healthcare Provider Details

I. General information

NPI: 1447875034
Provider Name (Legal Business Name): AADITEE HEPBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W LAKE FAITH DR
MAITLAND FL
32751-4322
US

IV. Provider business mailing address

317 W LAKE FAITH DR
MAITLAND FL
32751-4322
US

V. Phone/Fax

Practice location:
  • Phone: 386-479-0073
  • Fax:
Mailing address:
  • Phone: 386-479-0073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number923
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: