Healthcare Provider Details

I. General information

NPI: 1205756632
Provider Name (Legal Business Name): LEIDIANA AMOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 NIKKI CT APT 2
ORLANDO FL
32822-5787
US

IV. Provider business mailing address

4615 NIKKI CT APT 2
ORLANDO FL
32822-5787
US

V. Phone/Fax

Practice location:
  • Phone: 786-833-1153
  • Fax:
Mailing address:
  • Phone: 786-833-1153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA109846
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: