Healthcare Provider Details

I. General information

NPI: 1699428409
Provider Name (Legal Business Name): NADINE HENRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 S KIRKMAN RD STE 310
ORLANDO FL
32819-7937
US

IV. Provider business mailing address

449 W SILVER STAR RD UNIT 669
OCOEE FL
34761-8027
US

V. Phone/Fax

Practice location:
  • Phone: 407-337-3169
  • Fax: 833-457-0883
Mailing address:
  • Phone: 407-446-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: NADINE HENRY
Title or Position: LICENSED SCHOOL PSYCHOLOGIST
Credential: MS
Phone: 407-446-2223