MEDICARE: ELEANOR AVERY MENDOZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	SL7377	FL

General Provider Information

NPI Number	:	1154144269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEANOR AVERY MENDOZA

Provider Business Mailing Address
First Line	:	6940 SW 63RD CT
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-3345
Country	:	US
Telephone Number	:	773-456-1240
Fax Number	:

Provider Business Practice Location Address
First Line	:	6940 SW 63RD CT
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-3345
Country	:	US
Telephone Number	:	773-456-1240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2024
Last Update Date	:	11/06/2024

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Directions to “ ELEANOR AVERY MENDOZA ” Practice Location

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