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NPI Code Detail

MEDICARE: 14 FIFTY CORP

MEDICARE: 14 FIFTY CORP
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
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1982596383
Entity Type Code : Organization
Provider Name (Legal Business Name) : 14 FIFTY CORP
Provider Business Mailing Address
First Line : 1450 CHIPPEWA LN
Second Line :
City : GENEVA
State : FL
Zip : 32732-9183
Country : US
Telephone Number : 407-906-0140
Fax Number : 800-826-9197
Provider Business Practice Location Address
First Line : 1073 WILLA SPRINGS DR STE 2045
Second Line :
City : WINTER SPRINGS
State : FL
Zip : 32708-6625
Country : US
Telephone Number : 407-906-0140
Fax Number : 800-826-9197
Authorized Official
Title or Position : PRESIDENT
Name : SANDRA TIBALDEO
Credential :
Telephone Number : 407-906-0140
Provider Enumeration Date : 07/18/2025
Last Update Date : 07/19/2025

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Directions to “14 FIFTY CORP ” Practice Location

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