Healthcare Provider Details

I. General information

NPI: 1174544217
Provider Name (Legal Business Name): FLORIDA SPEECH-LANGUAGE PATHOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 S ALAFAYA TRL SUITE 101
ORLANDO FL
32828-8926
US

IV. Provider business mailing address

734 SENECA MEADOWS RD
WINTER SPRINGS FL
32708-4722
US

V. Phone/Fax

Practice location:
  • Phone: 407-340-4167
  • Fax: 407-327-7902
Mailing address:
  • Phone: 407-340-4167
  • Fax: 407-327-7902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberSA6843
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA6843
License Number StateFL

VIII. Authorized Official

Name: MRS. MELISSA D MALANI
Title or Position: OWNER/SPEECH PATHOLOGIST
Credential: MA, CCC-SLP
Phone: 407-340-4167