Provider Demographics
NPI:1104795814
Name:PEACO, SOPHIA ADELINA (PSYD)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:ADELINA
Last Name:PEACO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 LOOKOUT PL STE 202
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4485
Mailing Address - Country:US
Mailing Address - Phone:833-769-3524
Mailing Address - Fax:407-232-9437
Practice Address - Street 1:260 LOOKOUT PL STE 202
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4485
Practice Address - Country:US
Practice Address - Phone:833-769-3524
Practice Address - Fax:407-232-9437
Is Sole Proprietor?:No
Enumeration Date:2025-10-31
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY12961103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist