Provider Demographics
NPI:1093990004
Name:FELICIANO, MARIALID (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARIALID
Middle Name:
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 GIRARD DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-5267
Mailing Address - Country:US
Mailing Address - Phone:407-825-9447
Mailing Address - Fax:407-957-3416
Practice Address - Street 1:1025 GIRARD DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-5267
Practice Address - Country:US
Practice Address - Phone:407-825-9447
Practice Address - Fax:407-957-3416
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6687235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist