Healthcare Provider Details

I. General information

NPI: 1932099488
Provider Name (Legal Business Name): IRELIS FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 LANGLEY PL APT 205
SAINT CLOUD FL
34769-7226
US

IV. Provider business mailing address

2900 LANGLEY PL APT 205
SAINT CLOUD FL
34769-7226
US

V. Phone/Fax

Practice location:
  • Phone: 305-924-6144
  • Fax:
Mailing address:
  • Phone: 305-924-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number7253
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: