Basic Information
| Provider Information | |||||||||
| NPI: | 1740725472 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LECUSAY | ||||||||
| FirstName: | GABRIEL | ||||||||
| MiddleName: | OSCAR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1420 WATERFORD OAK DR | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328286011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545910445 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7950 LAKE UNDERHILL RD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328228229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076582046 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2017 | ||||||||
| LastUpdateDate: | 07/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | SZ7937 | FL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 235Z00000X | SA15947 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.