Healthcare Provider Details

I. General information

NPI: 1518564913
Provider Name (Legal Business Name): STACEY MARIE NUNEZ SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 S ORANGE BLOSSOM TRL STE 102
ORLANDO FL
32809-5734
US

IV. Provider business mailing address

2407 SWEETBRIAR CT
KISSIMMEE FL
34744-2625
US

V. Phone/Fax

Practice location:
  • Phone: 321-445-1287
  • Fax:
Mailing address:
  • Phone: 407-361-2741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI2252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: