Healthcare Provider Details

I. General information

NPI: 1467208736
Provider Name (Legal Business Name): IM NEUROSPEECH & SWALLOW SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2024
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 NW 82ND AVE STE 400
DORAL FL
33166-7602
US

IV. Provider business mailing address

5335 NW 87TH AVE STE 109-116
DORAL FL
33178-2833
US

V. Phone/Fax

Practice location:
  • Phone: 786-763-0480
  • Fax: 786-206-3476
Mailing address:
  • Phone: 786-763-0480
  • Fax: 786-206-3476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ISABEL MELENDEZ
Title or Position: SPEECH AND LANGUAGE PATHOLOGIST
Credential: MS CCC-SLP
Phone: 786-763-0480