Healthcare Provider Details

I. General information

NPI: 1033832936
Provider Name (Legal Business Name): SHARE YOUR STORY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7208 W SAND LAKE RD STE 305
ORLANDO FL
32819-5279
US

IV. Provider business mailing address

7208 W SAND LAKE RD STE 305
ORLANDO FL
32819-5279
US

V. Phone/Fax

Practice location:
  • Phone: 407-235-5498
  • Fax:
Mailing address:
  • Phone: 407-235-5498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EILEEN DIAZ
Title or Position: OWNER
Credential:
Phone: 407-235-4598