Provider Demographics
NPI:1154803906
Name:BRAUN, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:BRAUN
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 1:1327 SABLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2951
Mailing Address - Country:US
Mailing Address - Phone:954-816-5994
Mailing Address - Fax:
Practice Address - Street 1:925 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1212
Practice Address - Country:US
Practice Address - Phone:954-816-5994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8716235Z00000X
FLSA17664235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSZ8716OtherFLORIDA DEPARTMENT OF HEALTH
FLSA17664OtherFLORIDA DEPARTMENT OF HEALTH