Healthcare Provider Details

I. General information

NPI: 1467853390
Provider Name (Legal Business Name): ANA MARIE VELEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12901 BROLEMAN RD
ORLANDO FL
32832-6107
US

IV. Provider business mailing address

12901 BROLEMAN RD
ORLANDO FL
32832-6107
US

V. Phone/Fax

Practice location:
  • Phone: 407-641-0808
  • Fax: 407-812-4358
Mailing address:
  • Phone:
  • Fax: 407-812-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: