Healthcare Provider Details

I. General information

NPI: 1861328080
Provider Name (Legal Business Name): DOMINIQUE CETALE MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 BRICKELL AVE
MIAMI FL
33131-3915
US

IV. Provider business mailing address

1060 BRICKELL AVE APT 2713
MIAMI FL
33131-3923
US

V. Phone/Fax

Practice location:
  • Phone: 619-922-6027
  • Fax:
Mailing address:
  • Phone: 619-922-6027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA24306
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: