Provider Demographics
NPI:1396879938
Name:VANSANT, MARIA GABRIELA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:GABRIELA
Last Name:VANSANT
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 1:1110 DOVE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3021
Mailing Address - Country:US
Mailing Address - Phone:407-970-2940
Mailing Address - Fax:407-539-2408
Practice Address - Street 1:630 N MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4423
Practice Address - Country:US
Practice Address - Phone:407-539-2488
Practice Address - Fax:407-539-2408
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6324235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891736100Medicaid