Provider Demographics
NPI:1174016265
Name:MARINELLO, HEATHER (AUD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MARINELLO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6966 LONG NEEDLE CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-3095
Mailing Address - Country:US
Mailing Address - Phone:407-860-7241
Mailing Address - Fax:
Practice Address - Street 1:ORLANDO VA MEDICAL CENTER- AUDIOLOGY DEPARTMENT
Practice Address - Street 2:13800 VETERANS WAY
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827
Practice Address - Country:US
Practice Address - Phone:407-631-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2190231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist