Healthcare Provider Details

I. General information

NPI: 1881264216
Provider Name (Legal Business Name): MARIA YOLANDA CUCITI SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12545 ORANGE DR STE 502
DAVIE FL
33330-4306
US

IV. Provider business mailing address

701 SW 158TH TER
SUNRISE FL
33326-2112
US

V. Phone/Fax

Practice location:
  • Phone: 954-474-8048
  • Fax:
Mailing address:
  • Phone: 917-685-8012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number3112
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ10137
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: