Provider Demographics
NPI:1043678964
Name:RIVAS, AMARYLIS (SPLA)
Entity Type:Individual
Prefix:
First Name:AMARYLIS
Middle Name:
Last Name:RIVAS
Suffix:
Gender:F
Credentials:SPLA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 SAXON BLVD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-5971
Mailing Address - Country:US
Mailing Address - Phone:321-946-3932
Mailing Address - Fax:
Practice Address - Street 1:631 E OAK RIDGE RD
Practice Address - Street 2:STE 2
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4266
Practice Address - Country:US
Practice Address - Phone:321-400-7535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI22952355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant