Healthcare Provider Details

I. General information

NPI: 1578848784
Provider Name (Legal Business Name): LANA A BAYONA M.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W MICHIGAN ST
ORLANDO FL
32805-6203
US

IV. Provider business mailing address

601 W MICHIGAN ST
ORLANDO FL
32805-6203
US

V. Phone/Fax

Practice location:
  • Phone: 407-317-7430
  • Fax: 407-648-4150
Mailing address:
  • Phone: 407-317-7430
  • Fax: 407-648-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: