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General NPI Number Information
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NPI Number | 1669064499
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Entity Type | Individual
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Provider Name | JOSHUA THEODORE MORAN
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Gender | Male
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Dates
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Enumeration Date | 02/03/2021
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 111 E LAKE MARY BLVD STE 3
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City | SANFORD
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State | FL
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Zip | 32773-7111
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Country | US
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Telephone | 417-203-9492
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Fax |
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Provider Business Mailing Address
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Address Line | 12084 LAKE CYPRESS CIR APT 308
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City | ORLANDO
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State | FL
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Zip | 32828-7057
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Country | US
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Telephone | 561-706-8908
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 4700
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License Number State | FL
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