Healthcare Provider Details

I. General information

NPI: 1083123723
Provider Name (Legal Business Name): CASSANDRA SMITH M.S., CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 09/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 SARNO RD
MELBOURNE FL
32934-7229
US

IV. Provider business mailing address

3056 PARTIN SETTLEMENT RD
KISSIMMEE FL
34744-5422
US

V. Phone/Fax

Practice location:
  • Phone: 321-255-2625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ8291
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: