Healthcare Provider Details

I. General information

NPI: 1336515485
Provider Name (Legal Business Name): KELLY NICOLE DAY CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY NICOLE WHEELER

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1858 N ALAFAYA TRL STE 207
ORLANDO FL
32826-4754
US

IV. Provider business mailing address

8649 NARCISSUS AVE
SEMINOLE FL
33777-3339
US

V. Phone/Fax

Practice location:
  • Phone: 407-900-5313
  • Fax: 888-972-5443
Mailing address:
  • Phone: 813-454-3981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ 7191
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA15823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: