Healthcare Provider Details

I. General information

NPI: 1457704488
Provider Name (Legal Business Name): ISABEL DE CARVALHO MENDES PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10743 SW 104TH ST
MIAMI FL
33176-8163
US

IV. Provider business mailing address

1541 BRICKELL AVE AP 509
MIAMI FL
33129-1213
US

V. Phone/Fax

Practice location:
  • Phone: 305-224-7883
  • Fax: 305-274-4271
Mailing address:
  • Phone: 786-527-1975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ7601
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: