1174544217 NPI number — FLORIDA SPEECH-LANGUAGE PATHOLOGY, INC.

Table of content: (NPI 1174544217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174544217 NPI number — FLORIDA SPEECH-LANGUAGE PATHOLOGY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA SPEECH-LANGUAGE PATHOLOGY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174544217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
734 SENECA MEADOWS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32708-4722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-340-4167
Provider Business Mailing Address Fax Number:
407-327-7902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1525 S ALAFAYA TRL
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32828-8926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-340-4167
Provider Business Practice Location Address Fax Number:
407-327-7902
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MALANI
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER/SPEECH PATHOLOGIST
Authorized Official Telephone Number:
407-340-4167

Provider Taxonomy Codes

  • Taxonomy code: 222Q00000X , with the licence number:  SA6843 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SA6843 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 889917700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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