Healthcare Provider Details

I. General information

NPI: 1003414640
Provider Name (Legal Business Name): ADYANA RAQUEL MEJIAS DE LEON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 GOLF CLUB PKWY
ORLANDO FL
32808-4800
US

IV. Provider business mailing address

1020 ABERNATHY LN APT 306
APOPKA FL
32703-8693
US

V. Phone/Fax

Practice location:
  • Phone: 407-904-0134
  • Fax:
Mailing address:
  • Phone: 787-235-6002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI3614
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: