Provider Demographics
NPI:1295186070
Name:MIKALONIS, NUBIA YINED (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NUBIA
Middle Name:YINED
Last Name:MIKALONIS
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 1:8173 TERRAZA CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-8715
Mailing Address - Country:US
Mailing Address - Phone:917-621-7650
Mailing Address - Fax:
Practice Address - Street 1:8173 TERRAZA CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-8715
Practice Address - Country:US
Practice Address - Phone:917-621-7650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7282235Z00000X
FLSA15141235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist