Healthcare Provider Details

I. General information

NPI: 1003752957
Provider Name (Legal Business Name): OLIVIA S SIPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12064 SPRITE LN
ORLANDO FL
32832-6593
US

IV. Provider business mailing address

437 LONG AND WINDING RD
GROVELAND FL
34737-4617
US

V. Phone/Fax

Practice location:
  • Phone: 321-303-6276
  • Fax: 407-537-9772
Mailing address:
  • Phone: 954-328-5210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA23108
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: