Healthcare Provider Details

I. General information

NPI: 1891298667
Provider Name (Legal Business Name): LAUREN SYDNEY WALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2018
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9907 PINEY POINT CIR
ORLANDO FL
32825-6551
US

IV. Provider business mailing address

9907 PINEY POINT CIR
ORLANDO FL
32825-6551
US

V. Phone/Fax

Practice location:
  • Phone: 513-886-6439
  • Fax:
Mailing address:
  • Phone: 513-886-6439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA102623
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW510
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.015501
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: