Healthcare Provider Details

I. General information

NPI: 1558387399
Provider Name (Legal Business Name): JEFFREY HERMAN ED.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 E COLONIAL DR SUITE 107
ORLANDO FL
32803-5200
US

IV. Provider business mailing address

4401 E COLONIAL DR SUITE 107
ORLANDO FL
32803-5200
US

V. Phone/Fax

Practice location:
  • Phone: 407-898-5060
  • Fax: 407-898-5185
Mailing address:
  • Phone: 407-898-5060
  • Fax: 407-898-5185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA1530
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberSA1530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: