Healthcare Provider Details

I. General information

NPI: 1164352456
Provider Name (Legal Business Name): JULIA FARIAS BIBOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14393 BRIDGEWATER CROSSINGS BLVD
WINDERMERE FL
34786-3259
US

IV. Provider business mailing address

2699 RIDGETOP LN
CLERMONT FL
34711-7539
US

V. Phone/Fax

Practice location:
  • Phone: 407-784-6939
  • Fax:
Mailing address:
  • Phone: 224-413-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI8464
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: