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14055 Town Loop Blvd Suite 300 Orlando FL 32837-6105 | |
| (407) 857-6285 | |
| (407) 857-9566 |
| Full Name | |
|---|---|
| Speciality | Speech-Language Pathologist |
| Location | 14055 Town Loop Blvd, Orlando, Florida |
| Authorized Official Name and Position | Rachel Lee Shockley (PRESIDENT) |
| Authorized Official Contact | 4078576285 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
14055 Town Loop Blvd Suite 300 Orlando FL 32837-6105 Ph: (407) 857-6285 | 14055 Town Loop Blvd Suite 300 Orlando FL 32837-6105 Ph: (407) 857-6285 |
| NPI Number | 1356318489 |
|---|---|
| Provider Enumeration Date | 03/07/2006 |
| Last Update Date | 02/09/2022 |
| Certification Date | 02/09/2022 |
| Medicare PECOS PAC ID | 6204114655 |
|---|---|
| Medicare Enrollment ID | O20161105000183 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356318489 | NPI | - | NPPES |
| 011139400 | Medicaid | FL | |
| 888071900 | Medicaid | FL | |
| 017452500 | Medicaid | FL | |
| 812053600 | Medicaid | FL |
| Provider Name | Rachel L Shockley |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1891703930 PECOS PAC ID: 0749568194 Enrollment ID: I20161105000199 |
| Provider Name | Nicole Medina |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1922736099 PECOS PAC ID: 7618353681 Enrollment ID: I20220928000766 |
| Provider Name | Anthony Hernandez |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1730820556 PECOS PAC ID: 3678959657 Enrollment ID: I20220928001434 |
| Provider Name | Lorena Borda |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1467891481 PECOS PAC ID: 5597141457 Enrollment ID: I20220929001177 |
| Provider Name | Erica Benavides |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1780268441 PECOS PAC ID: 8224414115 Enrollment ID: I20220929002487 |
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