Healthcare Provider Details

I. General information

NPI: 1922903152
Provider Name (Legal Business Name): PAOLA MARIE CANCEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35950 U.S. 19 APT 3211
PALM HARBOR FL
34684
US

IV. Provider business mailing address

35950 US HIGHWAY 19 N UNIT 3211
PALM HARBOR FL
34684-1575
US

V. Phone/Fax

Practice location:
  • Phone: 787-315-3985
  • Fax:
Mailing address:
  • Phone: 787-315-3985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number005293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: