Healthcare Provider Details

I. General information

NPI: 1245789213
Provider Name (Legal Business Name): BRYANNA MOLINA SLPD, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 BISCAYNE BLVD STE 312
MIAMI FL
33181-3151
US

IV. Provider business mailing address

1986 BIARRITZ DR APT 106
MIAMI BEACH FL
33141-4427
US

V. Phone/Fax

Practice location:
  • Phone: 786-206-4151
  • Fax:
Mailing address:
  • Phone: 917-502-5957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number025921
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA15297
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: