Provider Demographics
NPI:1912262528
Name:D'MEZA, ASTRID AILEEN (BA, MED)
Entity Type:Individual
Prefix:
First Name:ASTRID
Middle Name:AILEEN
Last Name:D'MEZA
Suffix:
Gender:F
Credentials:BA, MED
Other - Prefix:
Other - First Name:PRODIGIOUS LEARNING
Other - Middle Name:
Other - Last Name:INTERVENTIONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:660 TERRACE SPRING DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6762
Mailing Address - Country:US
Mailing Address - Phone:407-630-0416
Mailing Address - Fax:
Practice Address - Street 1:5730 HAMLIN GROVES TRL
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5792
Practice Address - Country:US
Practice Address - Phone:407-347-7052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 222Q00000X
FL1149581252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist