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General NPI Number Information
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NPI Number | 1902033962
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Entity Type | Individual
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Provider Name | ALBERT VILLANUEVA-REYES EDD, MSC, CCC-SLP
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Gender | Male
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Dates
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Enumeration Date | 06/17/2009
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Last Update Date | 12/05/2017
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Provider Practice Location Address
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Address Line | 2674 SIMPSON RD
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City | KISSIMMEE
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State | FL
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Zip | 34744-4674
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Country | US
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Telephone | 407-408-2300
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Fax | 866-697-7393
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Provider Business Mailing Address
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Address Line | 2674 SIMPSON ROAD
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City | KISSIMMEE
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State | FL
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Zip | 34744-0001
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Country | US
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Telephone | 787-461-3700
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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 | 15857
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 473
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License Number State | PR
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