Healthcare Provider Details

I. General information

NPI: 1851226328
Provider Name (Legal Business Name): ISABELLE ELISE FEDERICO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ISABELLE ELISE WHALEN

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 W EAU GALLIE BLVD STE 180
MELBOURNE FL
32934-7277
US

IV. Provider business mailing address

1424 HAMPTON PARK LN
MELBOURNE FL
32940-8143
US

V. Phone/Fax

Practice location:
  • Phone: 321-255-6627
  • Fax:
Mailing address:
  • Phone: 321-544-7879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13350
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: