Healthcare Provider Details

I. General information

NPI: 1053224295
Provider Name (Legal Business Name): SOPHIA VERNALES FESTEJO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9367 TREVARTHON RD
ORLANDO FL
32817-2609
US

IV. Provider business mailing address

460 TERRAVISTA PL
OVIEDO FL
32765-3715
US

V. Phone/Fax

Practice location:
  • Phone: 407-201-7429
  • Fax:
Mailing address:
  • Phone: 407-432-5240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: