Provider Demographics
NPI:1851457543
Name:GAYDOS, DEANNE
Entity Type:Individual
Prefix:MRS
First Name:DEANNE
Middle Name:
Last Name:GAYDOS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DEANNE
Other - Middle Name:
Other - Last Name:ROLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2325 BLOSSOMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6177
Mailing Address - Country:US
Mailing Address - Phone:407-977-1761
Mailing Address - Fax:
Practice Address - Street 1:12377 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6215
Practice Address - Country:US
Practice Address - Phone:407-857-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2693235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8866635Medicaid