Healthcare Provider Details

I. General information

NPI: 1639753577
Provider Name (Legal Business Name): ALEJANDRA DEMAIO IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 CROSBY WAY
WINTER PARK FL
32792-4119
US

IV. Provider business mailing address

9907 PINEY POINT CIR
ORLANDO FL
32825-6551
US

V. Phone/Fax

Practice location:
  • Phone: 407-780-5515
  • Fax:
Mailing address:
  • Phone: 407-780-5515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-29164
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: