Healthcare Provider Details

I. General information

NPI: 1942780705
Provider Name (Legal Business Name): ASHLEY MEDINA-YNTEMA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6931 W SUNRISE BLVD
PLANTATION FL
33313-4406
US

IV. Provider business mailing address

5720 S PLUM BAY PKWY
TAMARAC FL
33321-6300
US

V. Phone/Fax

Practice location:
  • Phone: 954-583-6200
  • Fax:
Mailing address:
  • Phone: 954-401-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA14248
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: