Healthcare Provider Details

I. General information

NPI: 1962860437
Provider Name (Legal Business Name): CHAGNY PONS GRANADO SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7975 NW 154TH ST
MIAMI LAKES FL
33016-5863
US

IV. Provider business mailing address

1845 SW 87TH PL
MIAMI FL
33165-7844
US

V. Phone/Fax

Practice location:
  • Phone: 786-380-8595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA16070
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: