Healthcare Provider Details

I. General information

NPI: 1962317214
Provider Name (Legal Business Name): MAGGIE LESSILA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 E 1ST ST STE 1
SANFORD FL
32771-1467
US

IV. Provider business mailing address

924 CHICKADEE DR
PORT ORANGE FL
32127-4772
US

V. Phone/Fax

Practice location:
  • Phone: 407-942-3107
  • Fax:
Mailing address:
  • Phone: 262-623-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16037
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: