Healthcare Provider Details

I. General information

NPI: 1720991904
Provider Name (Legal Business Name): PEDIATRIC SPEECH SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 NE WHITE PINE TER
OCEAN BREEZE FL
34957-5786
US

IV. Provider business mailing address

1353 NE WHITE PINE TER
OCEAN BREEZE FL
34957-5786
US

V. Phone/Fax

Practice location:
  • Phone: 407-489-1087
  • Fax:
Mailing address:
  • Phone: 407-489-1087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MELISSA KELLY
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MA,CCC-SLP
Phone: 407-489-1087