MEDICARE: ESTEFANIA BAUTISTA

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	235Z00000X	Speech-Language Pathologist	30004952	NC

General Provider Information

NPI Number	:	1659211811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTEFANIA BAUTISTA

Provider Business Mailing Address
First Line	:	2010 N BREVARD ST APT 604
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-3946
Country	:	US
Telephone Number	:	707-932-1872
Fax Number	:

Provider Business Practice Location Address
First Line	:	1343 E GARRISON BLVD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-5137
Country	:	US
Telephone Number	:	704-785-0560
Fax Number	:	980-224-8387

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

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	03/30/2026

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Directions to “ ESTEFANIA BAUTISTA ” Practice Location

Language	Start Address	Practice Location

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