Healthcare Provider Details

I. General information

NPI: 1902736770
Provider Name (Legal Business Name): MADISON NEVELLE LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 W WATERS AVE
TAMPA FL
33614-2716
US

IV. Provider business mailing address

3701 HOLLOW WOOD DR
VALRICO FL
33596-6358
US

V. Phone/Fax

Practice location:
  • Phone: 813-776-6884
  • Fax:
Mailing address:
  • Phone: 813-416-8884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: