Healthcare Provider Details

I. General information

NPI: 1235062811
Provider Name (Legal Business Name): LISIE PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3804 N ORANGE BLOSSOM TRL
ORLANDO FL
32804-2772
US

IV. Provider business mailing address

3804 N ORANGE BLOSSOM TRL
ORLANDO FL
32804-2772
US

V. Phone/Fax

Practice location:
  • Phone: 407-720-1790
  • Fax:
Mailing address:
  • Phone: 407-720-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY SALVADOR
Title or Position: MANAGER
Credential:
Phone: 407-720-1790