Healthcare Provider Details

I. General information

NPI: 1659289825
Provider Name (Legal Business Name): MAYRA A HERNANDEZ LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2813 S HIAWASSEE RD STE 103
ORLANDO FL
32835-6689
US

IV. Provider business mailing address

6214 PEREGRINE CT
ORLANDO FL
32819-7565
US

V. Phone/Fax

Practice location:
  • Phone: 754-304-1348
  • Fax:
Mailing address:
  • Phone: 754-304-1348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA107585
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: