Healthcare Provider Details

I. General information

NPI: 1942133624
Provider Name (Legal Business Name): ROXANA JUNE WHEELER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

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

111 NATURE WALK PKWY UNIT 108
SAINT AUGUSTINE FL
32092-3065
US

IV. Provider business mailing address

318 COLORADO SPRINGS WAY
SAINT AUGUSTINE FL
32092-1929
US

V. Phone/Fax

Practice location:
  • Phone: 904-328-7489
  • Fax:
Mailing address:
  • Phone: 904-484-4173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13296
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: