MEDICARE: IVONNE CALCEDO SENIOR SUPPORT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1073461877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IVONNE CALCEDO SENIOR SUPPORT LLC

Provider Business Mailing Address
First Line	:	658 WREN DR
Second Line	:
City	:	CASSELBERRY
State	:	FL
Zip	:	32707-4817
Country	:	US
Telephone Number	:	407-807-9256
Fax Number	:

Provider Business Practice Location Address
First Line	:	658 WREN DR
Second Line	:
City	:	CASSELBERRY
State	:	FL
Zip	:	32707-4817
Country	:	US
Telephone Number	:	407-807-9256
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	IVONNE CALCEDO
Credential	:	MANAGER
Telephone Number	:	407-807-9256

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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