Healthcare Provider Details

I. General information

NPI: 1053288969
Provider Name (Legal Business Name): MADISON BOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date: 01/20/2026
Reactivation Date: 01/28/2026

III. Provider practice location address

1820 ARMSTRONG BLVD
KISSIMMEE FL
34741-2589
US

IV. Provider business mailing address

1746 FOXHALL CIR
KISSIMMEE FL
34741-2919
US

V. Phone/Fax

Practice location:
  • Phone: 407-852-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: