MEDICARE: MERIDIAN ASSOCIATES, 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	251B00000X	Case Management Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1780978445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDIAN ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	12226 CORPORATE BLVD STE 142
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-8388
Country	:	US
Telephone Number	:	407-601-3615
Fax Number	:	386-200-5919

Provider Business Practice Location Address
First Line	:	934 N MAGNOLIA AVE STE 327
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-3840
Country	:	US
Telephone Number	:	407-601-3615
Fax Number	:	386-200-5919

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. EVELYN ELIZABETH CLEGG
Credential	:	MSW
Telephone Number	:	407-496-2192

Provider Enumeration Date	:	05/30/2011
Last Update Date	:	03/19/2025

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