Provider Demographics
NPI:1104429158
Name:FELICIANO COLON, YASSEL (MA SLP-CF)
Entity type:Individual
Prefix:
First Name:YASSEL
Middle Name:
Last Name:FELICIANO COLON
Suffix:
Gender:F
Credentials:MA SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 INTERNATIONAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3625
Mailing Address - Country:US
Mailing Address - Phone:866-610-0580
Mailing Address - Fax:
Practice Address - Street 1:1201 WINTER GARDEN VINELAND RD STE 10
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4380
Practice Address - Country:US
Practice Address - Phone:407-654-5455
Practice Address - Fax:407-654-5829
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ11698235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist