Provider Demographics
NPI:1447956818
Name:CAMPANELLA, ANA RAQUEL
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:RAQUEL
Last Name:CAMPANELLA
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 1:2800 MONTICELLO PL APT 103
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2903
Mailing Address - Country:US
Mailing Address - Phone:631-317-3077
Mailing Address - Fax:
Practice Address - Street 1:2800 MONTICELLO PL APT 103
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-2903
Practice Address - Country:US
Practice Address - Phone:631-317-3077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL59672355A2700X, 2355S0801X
2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9523002708Medicaid