Healthcare Provider Details

I. General information

NPI: 1902672520
Provider Name (Legal Business Name): KERRIANN DE MARIA B.S., L-SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S WEST CROWN POINT RD STE 150
WINTER GARDEN FL
34787-2917
US

IV. Provider business mailing address

9703 AVELLINO AVE UNIT 1424
ORLANDO FL
32819-8817
US

V. Phone/Fax

Practice location:
  • Phone: 407-905-8908
  • Fax:
Mailing address:
  • Phone: 561-818-8117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI5904
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: