Healthcare Provider Details

I. General information

NPI: 1639662828
Provider Name (Legal Business Name): AMYLEE ANN RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S WEST CROWN POINT RD
WINTER GARDEN FL
34787-2916
US

IV. Provider business mailing address

332 CAEN CT
KISSIMMEE FL
34759-3446
US

V. Phone/Fax

Practice location:
  • Phone: 407-905-8908
  • Fax:
Mailing address:
  • Phone: 689-280-1013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number7089
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: