1558584995 NPI number — MRS. MELISSA BARI CENTOFANTI M.S., CCC SLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558584995 NPI number — MRS. MELISSA BARI CENTOFANTI M.S., CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CENTOFANTI
Provider First Name:
MELISSA
Provider Middle Name:
BARI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEAMAN
Provider Other First Name:
MELISSA
Provider Other Middle Name:
BARI
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., CCC SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558584995
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14200 OAK RIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33325-3073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-370-0610
Provider Business Mailing Address Fax Number:
954-596-7753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
447 NW 73RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33317-1608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-583-7383
Provider Business Practice Location Address Fax Number:
954-583-7388
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SA 8137 , 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)





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