Provider Demographics
NPI:1629080874
Name:UNBRIDELED FASHIION, LLC
Entity type:Organization
Organization Name:UNBRIDELED FASHIION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANZANDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-325-8035
Mailing Address - Street 1:905 COCHRAN RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:FL
Mailing Address - Zip Code:32732-9294
Mailing Address - Country:US
Mailing Address - Phone:407-325-8035
Mailing Address - Fax:407-349-2253
Practice Address - Street 1:905 COCHRAN RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:FL
Practice Address - Zip Code:32732-9294
Practice Address - Country:US
Practice Address - Phone:407-325-8035
Practice Address - Fax:407-349-2253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA3515235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty