Provider Demographics
NPI:1760508949
Name:BRAY-TAYLOR, JOAN E
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:E
Last Name:BRAY-TAYLOR
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:PO BOX 555907
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32855-5907
Mailing Address - Country:US
Mailing Address - Phone:407-298-5300
Mailing Address - Fax:407-296-0026
Practice Address - Street 1:6388 SILVER STAR RD
Practice Address - Street 2:SUITE 2E
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-3235
Practice Address - Country:US
Practice Address - Phone:407-298-5300
Practice Address - Fax:407-296-0026
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 3157235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist