Provider Demographics
NPI:1164834743
Name:BORDON, JANICE KAY
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:KAY
Last Name:BORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-5446
Mailing Address - Country:US
Mailing Address - Phone:407-430-6273
Mailing Address - Fax:
Practice Address - Street 1:126 PINECREST DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-5446
Practice Address - Country:US
Practice Address - Phone:407-430-6273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLORI#FL922013ZMedicaid