Healthcare Provider Details

I. General information

NPI: 1770862955
Provider Name (Legal Business Name): SEABILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 OCEAN AVE STE 201A
MELBOURNE BEACH FL
32951-2568
US

IV. Provider business mailing address

PO BOX 510174
MELBOURNE BEACH FL
32951-0174
US

V. Phone/Fax

Practice location:
  • Phone: 855-757-4897
  • Fax: 855-757-4897
Mailing address:
  • Phone: 855-757-4897
  • Fax: 855-757-4897

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: MR. RICHARD C. FERNANDEZ
Title or Position: SPEECH PATHOLOGIST/ OWNER
Credential: M.S., CCC/SLP
Phone: 855-757-4897