Provider Demographics
NPI:1225756729
Name:MESTRE, JAZZMIN A
Entity Type:Individual
Prefix:
First Name:JAZZMIN
Middle Name:A
Last Name:MESTRE
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 1:111 E LAKE MARY BLVD STE 113
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-7111
Mailing Address - Country:US
Mailing Address - Phone:407-694-7838
Mailing Address - Fax:321-332-9768
Practice Address - Street 1:111 E LAKE MARY BLVD STE 113
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-7111
Practice Address - Country:US
Practice Address - Phone:407-203-9492
Practice Address - Fax:321-332-9768
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI57282355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty