Healthcare Provider Details

I. General information

NPI: 1982988309
Provider Name (Legal Business Name): FEDERICA CARULLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 W EAU GALLIE BLVD
MELBOURNE FL
32934-7213
US

IV. Provider business mailing address

4450 W EAU GALLIE BLVD
MELBOURNE FL
32934-7213
US

V. Phone/Fax

Practice location:
  • Phone: 321-255-6627
  • Fax:
Mailing address:
  • Phone: 321-255-6627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ5637
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: