Provider Demographics
NPI:1962176180
Name:FERDERER, TAYLOR S
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:S
Last Name:FERDERER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14242 CHEVAL MAYFAIRE DR APT 103
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7619
Mailing Address - Country:US
Mailing Address - Phone:407-617-1928
Mailing Address - Fax:
Practice Address - Street 1:11 E LANCASTER RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-6624
Practice Address - Country:US
Practice Address - Phone:407-852-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI47762355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant