Basic Information
| Provider Information | |||||||||
| NPI: | 1578034716 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DELGADO | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | G. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4001 ATRIUM DR | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328223739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7864471730 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1701 PARK CENTER DR STE 230 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328356235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3214451287 | ||||||||
| FaxNumber: | 4013867448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2018 | ||||||||
| LastUpdateDate: | 07/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 101907000 | 05 | FL | MEDICAID |