Provider Demographics
NPI:1548874431
Name:FITZGERALD, GISELLE BENITEZ
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:BENITEZ
Last Name:FITZGERALD
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 1:1341 CAMAS AVE NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-8090
Mailing Address - Country:US
Mailing Address - Phone:845-649-1281
Mailing Address - Fax:
Practice Address - Street 1:13574 VILLAGE PARK DR STE 205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7694
Practice Address - Country:US
Practice Address - Phone:407-990-2847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL44502355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant