Healthcare Provider Details

I. General information

NPI: 1104743640
Provider Name (Legal Business Name): MARY SARENA NAZARIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4780 DATA CT
ORLANDO FL
32817-8331
US

IV. Provider business mailing address

4700 LAKE SHARP DR
ORLANDO FL
32817-3157
US

V. Phone/Fax

Practice location:
  • Phone: 407-852-3300
  • Fax:
Mailing address:
  • Phone: 407-852-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI8891
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: