MEDICARE: ANDREW TATRO SLPA

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	SI 2904	FL

General Provider Information

NPI Number	:	1366999880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW TATRO SLPA

Provider Business Mailing Address
First Line	:	2001 GLENRIDGE WAY
Second Line	:	22
City	:	WINTER PARK
State	:	FL
Zip	:	32792-3015
Country	:	US
Telephone Number	:	321-947-4945
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 WESTWOOD SQ STE DW
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-8849
Country	:	US
Telephone Number	:	407-790-5601
Fax Number	:

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

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	04/10/2019

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