Healthcare Provider Details

I. General information

NPI: 1578278180
Provider Name (Legal Business Name): CONSUELO BORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6143 S ORANGE BLOSSOM TRL STE B
ORLANDO FL
32809-4609
US

IV. Provider business mailing address

6546 FAIRWAY HILL CT
ORLANDO FL
32835-5740
US

V. Phone/Fax

Practice location:
  • Phone: 407-858-8720
  • Fax:
Mailing address:
  • Phone: 772-342-3026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI5372
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: