Provider Demographics
NPI:1457969578
Name:QUERINO MATHIAS, HYEDA REGINA (MS-SLP)
Entity Type:Individual
Prefix:
First Name:HYEDA
Middle Name:REGINA
Last Name:QUERINO MATHIAS
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 THOROUGHBRED DR
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-5132
Mailing Address - Country:US
Mailing Address - Phone:407-202-8422
Mailing Address - Fax:
Practice Address - Street 1:3912 PORT SEA PL
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-1808
Practice Address - Country:US
Practice Address - Phone:407-421-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9945235Z00000X
FLSI43372355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist