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General NPI Number Information
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NPI Number | 1053985952
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Entity Type | Individual
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Provider Name | MS. CONSTANCE MAYA BREZDEN
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Gender | Female
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Dates
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Enumeration Date | 05/14/2021
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 1172 W OSCEOLA PKWY
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City | KISSIMMEE
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State | FL
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Zip | 34741-7515
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Country | US
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Telephone | 689-204-2221
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Fax | 689-204-2225
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Provider Business Mailing Address
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Address Line | 1019 W PEBBLE BEACH CIR
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City | WINTER SPGS
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State | FL
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Zip | 32708-4209
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Country | US
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Telephone | 407-766-6229
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SZ12167
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License Number State | FL
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