Provider Demographics
NPI:1568958577
Name:AYALA COSME, LERCY JANIRA
Entity Type:Individual
Prefix:
First Name:LERCY
Middle Name:JANIRA
Last Name:AYALA COSME
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 1:1413 WESTBURY DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-7145
Mailing Address - Country:US
Mailing Address - Phone:407-301-7475
Mailing Address - Fax:
Practice Address - Street 1:1413 WESTBURY DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-7145
Practice Address - Country:US
Practice Address - Phone:407-301-7475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No252Y00000XAgenciesEarly Intervention Provider Agency