Healthcare Provider Details

I. General information

NPI: 1205549078
Provider Name (Legal Business Name): CONSTELLATION SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2022
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5726 OLD CHENEY HWY
ORLANDO FL
32807-3525
US

IV. Provider business mailing address

7726 WINEGARD RD STE 53
ORLANDO FL
32809-7147
US

V. Phone/Fax

Practice location:
  • Phone: 407-900-5278
  • Fax:
Mailing address:
  • Phone: 407-900-5278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CORALIS CALDERON
Title or Position: OWNER
Credential:
Phone: 407-902-5919