Provider Demographics
NPI:1942576418
Name:MAYSONET ROBERTS, TATIANA (SLPA)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:MAYSONET ROBERTS
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9318 E COLONIAL DR
Mailing Address - Street 2:SUITE B3
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-4100
Mailing Address - Country:US
Mailing Address - Phone:407-281-3803
Mailing Address - Fax:407-249-8916
Practice Address - Street 1:9318 E COLONIAL DR
Practice Address - Street 2:SUITE B3
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-4100
Practice Address - Country:US
Practice Address - Phone:407-281-3803
Practice Address - Fax:407-249-8916
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI20552355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSI2055OtherFL LICENSE