MEDICARE: SANDRA MEREJILDO

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1861117947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA MEREJILDO

Provider Business Mailing Address
First Line	:	2920 WORDSMITH RD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-5680
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 S HIAWASSEE RD SUITE 203
Second Line	:	ROOM 1242
City	:	ORLANDO
State	:	FL
Zip	:	32835-3283
Country	:	US
Telephone Number	:	321-972-4039
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	10/11/2022

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Directions to “ SANDRA MEREJILDO ” Practice Location

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