Healthcare Provider Details

I. General information

NPI: 1508824574
Provider Name (Legal Business Name): ALLIETE ALFANO, SLP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 01/01/2024
Certification Date: 01/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4960 SW 72ND AVE STE 210
MIAMI FL
33155-5549
US

IV. Provider business mailing address

4960 SW 72ND AVE STE 210
MIAMI FL
33155-5549
US

V. Phone/Fax

Practice location:
  • Phone: 305-461-4702
  • Fax: 305-461-4702
Mailing address:
  • Phone: 305-461-4702
  • Fax: 305-461-4705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA5335
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLIETE ALFANO
Title or Position: PRESIDENT
Credential: PHD, CCC-SLP
Phone: 305-461-4702