Provider Demographics
NPI:1437829041
Name:MATI, BRIANNA DEA
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:DEA
Last Name:MATI
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 1:881 W WARREN AVE APT 360
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4050
Mailing Address - Country:US
Mailing Address - Phone:561-568-6103
Mailing Address - Fax:
Practice Address - Street 1:4780 DATA CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-8331
Practice Address - Country:US
Practice Address - Phone:407-904-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI51022355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant