Provider Demographics
NPI:1407273964
Name:CALENDRILLO, TALIA (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TALIA
Middle Name:
Last Name:CALENDRILLO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MS
Other - First Name:TALIA
Other - Middle Name:
Other - Last Name:PERNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1809 E BROADWAY ST # 122
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8597
Mailing Address - Country:US
Mailing Address - Phone:407-359-5693
Mailing Address - Fax:
Practice Address - Street 1:1000 W BROADWAY ST
Practice Address - Street 2:STE 214
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9260
Practice Address - Country:US
Practice Address - Phone:407-359-5693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-23
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14168235Z00000X
CA8915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018360200Medicaid