Healthcare Provider Details

I. General information

NPI: 1538595780
Provider Name (Legal Business Name): JAMIE MICHELLE ROIG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 VONDERBURG DR SUITE 201
BRANDON FL
33511-5900
US

IV. Provider business mailing address

602 VONDERBURG DR SUITE 201
BRANDON FL
33511-5900
US

V. Phone/Fax

Practice location:
  • Phone: 813-653-1149
  • Fax: 813-654-6644
Mailing address:
  • Phone: 813-653-1149
  • Fax: 813-654-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ6412
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: