Provider Demographics
NPI:1982198586
Name:LANDIS, LETITIA M (AUD)
Entity Type:Individual
Prefix:DR
First Name:LETITIA
Middle Name:M
Last Name:LANDIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LETITIA
Other - Middle Name:M
Other - Last Name:KRIEG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-984-3855
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:1223 GATEWAY DR STE 1E
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2607
Practice Address - Country:US
Practice Address - Phone:321-984-3855
Practice Address - Fax:321-984-8483
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2185231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLKI223OtherMEDICARE