Provider Demographics
NPI:1982596383
Name:14 FIFTY CORP
Entity type:Organization
Organization Name:14 FIFTY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIBALDEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-906-0140
Mailing Address - Street 1:1450 CHIPPEWA LN
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:FL
Mailing Address - Zip Code:32732-9183
Mailing Address - Country:US
Mailing Address - Phone:407-906-0140
Mailing Address - Fax:800-826-9197
Practice Address - Street 1:1073 WILLA SPRINGS DR STE 2045
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-6625
Practice Address - Country:US
Practice Address - Phone:407-906-0140
Practice Address - Fax:800-826-9197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-18
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty