Healthcare Provider Details

I. General information

NPI: 1528265204
Provider Name (Legal Business Name): MARIA LAURA DI CARLO CCC-MS-SLP-AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BAY DR APT 919
MIAMI BEACH FL
33141-5672
US

IV. Provider business mailing address

5120 SW 92ND TER
COOPER CITY FL
33328-4219
US

V. Phone/Fax

Practice location:
  • Phone: 305-397-8993
  • Fax: 305-763-8029
Mailing address:
  • Phone: 305-439-3488
  • Fax: 305-763-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY6289
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA8993
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: