Healthcare Provider Details

I. General information

NPI: 1669317558
Provider Name (Legal Business Name): LACEY GELFAND
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 NW 14TH ST
MIAMI FL
33136-2106
US

IV. Provider business mailing address

1121 NW 14TH ST
MIAMI FL
33136-2106
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-3564
  • Fax:
Mailing address:
  • Phone: 305-243-3564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13383
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: