Provider Demographics
NPI:1730599424
Name:CARMONA, MAYBELIN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MAYBELIN
Middle Name:
Last Name:CARMONA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4476 LUMBERDALE RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3310
Mailing Address - Country:US
Mailing Address - Phone:646-736-9096
Mailing Address - Fax:
Practice Address - Street 1:4476 LUMBERDALE RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-3310
Practice Address - Country:US
Practice Address - Phone:646-736-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA17762235Z00000X
CASP29967235Z00000X
NY025422235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
932368270OtherGHI-EMBLEM HEALTH