Healthcare Provider Details

I. General information

NPI: 1982351482
Provider Name (Legal Business Name): TANISHA POITEVIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 WATERFORD DISTRICT DR STE 150
MIAMI FL
33126-2024
US

IV. Provider business mailing address

3401 NW 212TH ST
MIAMI GARDENS FL
33056-1017
US

V. Phone/Fax

Practice location:
  • Phone: 954-538-8588
  • Fax:
Mailing address:
  • Phone: 561-768-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA24758
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSL5382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: