Healthcare Provider Details

I. General information

NPI: 1407500341
Provider Name (Legal Business Name): KAITLYN ZAVALA M.A. CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 S APOPKA VINELAND RD STE 100
ORLANDO FL
32819-3151
US

IV. Provider business mailing address

905 LAKE LILY DR APT C263
MAITLAND FL
32751-5698
US

V. Phone/Fax

Practice location:
  • Phone: 407-905-9300
  • Fax:
Mailing address:
  • Phone: 321-312-9743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ10539
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: