Healthcare Provider Details

I. General information

NPI: 1487391587
Provider Name (Legal Business Name): LILIAN MERCEDES OBANDO SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16800 NW 2ND AVE STE 301
NORTH MIAMI BEACH FL
33169-5508
US

IV. Provider business mailing address

16800 NW 2ND AVE STE 301
NORTH MIAMI BEACH FL
33169-5508
US

V. Phone/Fax

Practice location:
  • Phone: 786-206-4151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA23219
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: