Healthcare Provider Details

I. General information

NPI: 1134058365
Provider Name (Legal Business Name): LORRY LYN SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11602 LAKE UNDERHILL RD STE 129
ORLANDO FL
32825-4460
US

IV. Provider business mailing address

10913 MOSS PARK RD UNIT 935
ORLANDO FL
32832-6062
US

V. Phone/Fax

Practice location:
  • Phone: 407-277-5400
  • Fax:
Mailing address:
  • Phone: 239-398-4206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI7028
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: