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Organization
DECIR PEDIATRIC SPECIALTY
Active
Organization
DECIR PEDIATRIC SPECIALTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CONSUELO MONICA DE AVILA M.S., CCC-SLP (SPEECH-LANGUAGE PATHOLOGIST)
(954) 529-7194
Entity
Organization
Contact information
Practice address
1820 NESTLEWOOD TRL, ORLANDO, FL 32837-8011
(954) 529-7194
Mailing address
1820 NESTLEWOOD TRL, ORLANDO, FL 32837-8011
(954) 529-7194
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
13501
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016613600
—
FL
Enumeration date
03/31/2017
Last updated
03/31/2017
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