Healthcare Provider Details

I. General information

NPI: 1184533754
Provider Name (Legal Business Name): CASSICA NGUYEN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12701 S JOHN YOUNG PKWY STE 219
ORLANDO FL
32837-3423
US

IV. Provider business mailing address

14713 GRAND COVE DR
ORLANDO FL
32837-8179
US

V. Phone/Fax

Practice location:
  • Phone: 407-803-3909
  • Fax:
Mailing address:
  • Phone: 407-803-3909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13639
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: