Provider Demographics
NPI:1437901758
Name:MAGGIO, MARC
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:MAGGIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15186 SOUTHERN MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4872
Mailing Address - Country:US
Mailing Address - Phone:561-809-4116
Mailing Address - Fax:
Practice Address - Street 1:3200 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-3067
Practice Address - Country:US
Practice Address - Phone:561-809-4116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA21232235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist