Provider Demographics
NPI:1548400047
Name:VELASQUEZ, MAGDALIS (MA SLP)
Entity Type:Individual
Prefix:
First Name:MAGDALIS
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 BLUE JACKET LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-3339
Mailing Address - Country:US
Mailing Address - Phone:407-493-7253
Mailing Address - Fax:
Practice Address - Street 1:7209 CURRY FORD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5809
Practice Address - Country:US
Practice Address - Phone:407-421-7284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 4672235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist