Provider Demographics
NPI:1356020580
Name:SPURLOCK, ELIANA JONAY
Entity type:Individual
Prefix:MRS
First Name:ELIANA
Middle Name:JONAY
Last Name:SPURLOCK
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 1:182 LINLAKE CV APT 202
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7967
Mailing Address - Country:US
Mailing Address - Phone:689-209-4392
Mailing Address - Fax:
Practice Address - Street 1:2667 ENTERPRISE RD
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8217
Practice Address - Country:US
Practice Address - Phone:321-233-3534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI64072355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant