Healthcare Provider Details

I. General information

NPI: 1952816852
Provider Name (Legal Business Name): ANTAINETTE EWART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 PARK CENTER DR STE 230
ORLANDO FL
32835-6235
US

IV. Provider business mailing address

6173 RALEIGH ST APT 1704
ORLANDO FL
32835-2296
US

V. Phone/Fax

Practice location:
  • Phone: 321-445-1287
  • Fax:
Mailing address:
  • Phone: 407-272-1984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number6109
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: