MEDICARE: SUNSHINE SPEECH LANGUAGE PATHOLOGY CORP

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	SA11667	FL

General Provider Information

NPI Number	:	1851881304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE SPEECH LANGUAGE PATHOLOGY CORP

Provider Business Mailing Address
First Line	:	2585 SW EGRET POND CIR
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-2536
Country	:	US
Telephone Number	:	772-486-3328
Fax Number	:

Provider Business Practice Location Address
First Line	:	2585 SW EGRET POND CIR
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-2536
Country	:	US
Telephone Number	:	772-486-3328
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MOLLY VOGELI
Credential	:	M.A., CCC-SLP
Telephone Number	:	772-486-3328

Provider Enumeration Date	:	05/10/2018
Last Update Date	:	05/10/2018

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