Provider Demographics
NPI:1902033962
Name:VILLANUEVA-REYES, ALBERT (EDD, MSC, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:VILLANUEVA-REYES
Suffix:
Gender:M
Credentials:EDD, MSC, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2674 SIMPSON ROAD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-0001
Mailing Address - Country:US
Mailing Address - Phone:787-461-3700
Mailing Address - Fax:
Practice Address - Street 1:2674 SIMPSON RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4674
Practice Address - Country:US
Practice Address - Phone:407-408-2300
Practice Address - Fax:866-697-7393
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15857235Z00000X
PR473235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR473OtherPROFESSIONAL LICENSE