Healthcare Provider Details

I. General information

NPI: 1285942417
Provider Name (Legal Business Name): MELANIE ELISE GORIN M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21304 W DIXIE HWY
MIAMI FL
33180-1134
US

IV. Provider business mailing address

21304 W DIXIE HWY
MIAMI FL
33180-1134
US

V. Phone/Fax

Practice location:
  • Phone: 305-318-9158
  • Fax:
Mailing address:
  • Phone: 305-318-9158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA11228
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: