Provider Demographics
NPI:1194436055
Name:BUENO, ALEXANDRA T
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:T
Last Name:BUENO
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 1:12632 IVORY STONE LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-6741
Mailing Address - Country:US
Mailing Address - Phone:239-848-2700
Mailing Address - Fax:
Practice Address - Street 1:2370 BRUCE B DOWNS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-9215
Practice Address - Country:US
Practice Address - Phone:813-973-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist