Provider Demographics
NPI:1245911247
Name:GUILLAUME, CINDRA M
Entity type:Individual
Prefix:MS
First Name:CINDRA
Middle Name:M
Last Name:GUILLAUME
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 1:2055 ORANGE CENTER BLVD APT 11207
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-3547
Mailing Address - Country:US
Mailing Address - Phone:321-314-3376
Mailing Address - Fax:
Practice Address - Street 1:2055 ORANGE CENTER BLVD APT 11207
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-3547
Practice Address - Country:US
Practice Address - Phone:321-314-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251E00000X, 251E00000X
FL253Z00000X, 385HR2060X, 385HR2060X
FL381617251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services