1497044077 NPI number — ANTONINA E ALAVA MS-CCC-SLP

Table of content: ANTONINA E ALAVA MS-CCC-SLP (NPI 1497044077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497044077 NPI number — ANTONINA E ALAVA MS-CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALAVA
Provider First Name:
ANTONINA
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS-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:
LEVIGNE
Provider Other First Name:
ANTONIA
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497044077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8477 S SUNCOAST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMOSASSA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34446-5028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-382-7214
Provider Business Mailing Address Fax Number:
352-382-7781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1060 W STATE ROAD 434
Provider Second Line Business Practice Location Address:
STE 108
Provider Business Practice Location Address City Name:
LONGWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32750-4919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-260-0551
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2011

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:  SA11161 , 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: 114752600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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