Healthcare Provider Details

I. General information

NPI: 1700452281
Provider Name (Legal Business Name): MELANIE LIANNE CAJUSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12545 ORANGE DR
DAVIE FL
33330-4306
US

IV. Provider business mailing address

8931 NW 152ND ST
MIAMI LAKES FL
33018-1372
US

V. Phone/Fax

Practice location:
  • Phone: 954-474-8048
  • Fax:
Mailing address:
  • Phone: 786-352-4331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSI4011
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: