Healthcare Provider Details

I. General information

NPI: 1528850922
Provider Name (Legal Business Name): MATTHEW BERMUDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6953 UNIVERSITY BLVD
WINTER PARK FL
32792-6710
US

IV. Provider business mailing address

2723 HUNT CLUB LN
ORLANDO FL
32826-3683
US

V. Phone/Fax

Practice location:
  • Phone: 407-543-8356
  • Fax:
Mailing address:
  • Phone: 407-730-1929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-436597
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: