Provider Demographics
NPI:1003414640
Name:MEJIAS DE LEON, ADYANA RAQUEL
Entity type:Individual
Prefix:
First Name:ADYANA
Middle Name:RAQUEL
Last Name:MEJIAS DE LEON
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 1:1020 ABERNATHY LN APT 306
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-8693
Mailing Address - Country:US
Mailing Address - Phone:787-235-6002
Mailing Address - Fax:
Practice Address - Street 1:5800 GOLF CLUB PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-4800
Practice Address - Country:US
Practice Address - Phone:407-904-0134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI36142355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant