MEDICARE: CONCETTA BRUNO PA

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	SA1471	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790910297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCETTA BRUNO PA

Provider Business Mailing Address
First Line	:	1000 QUAYSIDE TER APT 1605
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33138-2220
Country	:	US
Telephone Number	:	786-325-8162
Fax Number	:	786-801-1199

Provider Business Practice Location Address
First Line	:	1000 QUAYSIDE TER APT 1605
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33138-2220
Country	:	US
Telephone Number	:	130-586-4378
Fax Number	:	395-865-5612

Authorized Official
Title or Position	:	SPEECH PATHOLOGIST/PRESIDENT
Name	:	MS. CONCETTA BRUNO
Credential	:	MA CCC
Telephone Number	:	305-864-3788

Provider Enumeration Date	:	05/27/2009
Last Update Date	:	07/20/2023

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Directions to “CONCETTA BRUNO PA ” Practice Location

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