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NPI Code Detail

MEDICARE: ALEXIS VICTORIA GEDALLOVICH

MEDICARE: ALEXIS VICTORIA GEDALLOVICH
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
1106S00000XBehavior Technician
2235Z00000XSpeech-Language PathologistSZ9468FL

General Provider Information

NPI Number : 1386169324
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXIS VICTORIA GEDALLOVICH
Provider Business Mailing Address
First Line : 4311 LONG KEY LN APT 19202
Second Line :
City : WINTER PARK
State : FL
Zip : 32792-6991
Country : US
Telephone Number : 954-298-8155
Fax Number :
Provider Business Practice Location Address
First Line : 3305 S ORANGE AVE
Second Line :
City : ORLANDO
State : FL
Zip : 32806-6125
Country : US
Telephone Number : 407-852-3347
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2017
Last Update Date : 02/05/2020

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Directions to “ ALEXIS VICTORIA GEDALLOVICH ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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