Organization
IVELISSE MEDINA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVELISSE MEDINA SLPA (OWNER)
(787) 479-6479
Entity
Organization
Contact information
Practice address
2275 FORTUNE RD, KISSIMMEE, FL 34744-4404
(407) 348-2060
Mailing address
12087 JEWEL FISH LN, ORLANDO, FL 32827-7141
(787) 479-6479
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
Primary
2200
FL
Other
Enumeration date
07/14/2016
Last updated
07/14/2016
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