Healthcare Provider Details

I. General information

NPI: 1790607489
Provider Name (Legal Business Name): LISET MENENDEZ GONZALEZ SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 RIDGEWOOD AVE
BRANDON FL
33510-4617
US

IV. Provider business mailing address

8006 FERNVIEW LN
TAMPA FL
33615-4517
US

V. Phone/Fax

Practice location:
  • Phone: 813-662-1060
  • Fax: 813-662-0530
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13398
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: