Healthcare Provider Details

I. General information

NPI: 1427594217
Provider Name (Legal Business Name): NOEL MCQUEEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 S SEMORAN BLVD SUITE 24
ORLANDO FL
32822-1747
US

IV. Provider business mailing address

5575 S SEMORAN BLVD SUITE 24
ORLANDO FL
32822-1747
US

V. Phone/Fax

Practice location:
  • Phone: 321-400-5254
  • Fax: 407-386-7454
Mailing address:
  • Phone: 321-400-5254
  • Fax: 407-386-7454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-66235
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: