Healthcare Provider Details

I. General information

NPI: 1811615412
Provider Name (Legal Business Name): BROOKLYN M SHEEHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 S. ORANGE BLOSSOM TRAIL #102
ORLANDO FL
32809
US

IV. Provider business mailing address

949 WESTPARK DR APT 104
CELEBRATION FL
34747-4948
US

V. Phone/Fax

Practice location:
  • Phone: 321-445-1287
  • Fax:
Mailing address:
  • Phone: 407-655-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number5690
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: