Provider Demographics
NPI:1962018739
Name:SAVASTANO, BRIANA LUCKIE
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:LUCKIE
Last Name:SAVASTANO
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 1:2125 SEAPORT CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1231
Mailing Address - Country:US
Mailing Address - Phone:954-218-1203
Mailing Address - Fax:
Practice Address - Street 1:111 E LAKE MARY BLVD STE 113
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-7111
Practice Address - Country:US
Practice Address - Phone:407-203-9492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI45402355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant