Healthcare Provider Details

I. General information

NPI: 1003728593
Provider Name (Legal Business Name): PRI'S VOICE GARDEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19148 PORTOFINO DR
TAMPA FL
33647-3086
US

IV. Provider business mailing address

19148 PORTOFINO DR
TAMPA FL
33647-3086
US

V. Phone/Fax

Practice location:
  • Phone: 718-844-6949
  • Fax:
Mailing address:
  • Phone: 718-844-6949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PRISCILLA MARIAH DE JESUS
Title or Position: OWNER/MANAGING MEMBER
Credential: M.S., CCC-SLP
Phone: 718-844-6949