MEDICARE: MISS RAQUEL MEDINA VALENTIN SLPA,ITDS

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	252Y00000X	Early Intervention Provider Agency		FL
2	2355S0801X	Speech-Language Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962908384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS RAQUEL MEDINA VALENTIN SLPA,ITDS

Provider Business Mailing Address
First Line	:	1737 ORANGE VIEW WAY
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-5403
Country	:	US
Telephone Number	:	787-508-1310
Fax Number	:

Provider Business Practice Location Address
First Line	:	4119 NEPTUNE RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6741
Country	:	US
Telephone Number	:	407-913-1010
Fax Number	:	407-992-8697

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

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	07/26/2021

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