Healthcare Provider Details

I. General information

NPI: 1518893510
Provider Name (Legal Business Name): PATRICE CYRINIA ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9626 PORTOFINO DR
ORLANDO FL
32832-5622
US

IV. Provider business mailing address

9626 PORTOFINO DR
ORLANDO FL
32832-5622
US

V. Phone/Fax

Practice location:
  • Phone: 407-701-7681
  • Fax:
Mailing address:
  • Phone: 407-701-7681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number939569
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH23866
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: