Healthcare Provider Details

I. General information

NPI: 1740429141
Provider Name (Legal Business Name): SUSANNA ROMERO M.S. CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5975 SUNSET DR STE 100
SOUTH MIAMI FL
33143-5198
US

IV. Provider business mailing address

6200 SW 73RD ST
SOUTH MIAMI FL
33143-4679
US

V. Phone/Fax

Practice location:
  • Phone: 786-662-5080
  • Fax: 786-662-5081
Mailing address:
  • Phone: 786-662-5080
  • Fax: 786-662-5081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA5858
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: