Provider Demographics
NPI:1346984176
Name:BACHAN, KAREENA ANNUPA (CF-SLP)
Entity Type:Individual
Prefix:
First Name:KAREENA
Middle Name:ANNUPA
Last Name:BACHAN
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1742 CIRCE LAKE CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4645
Mailing Address - Country:US
Mailing Address - Phone:954-812-3601
Mailing Address - Fax:
Practice Address - Street 1:950 S MELLONVILLE AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-2237
Practice Address - Country:US
Practice Address - Phone:407-322-8566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist