Healthcare Provider Details

I. General information

NPI: 1073839908
Provider Name (Legal Business Name): SUNSET SPEECH AND LANGUAGE PATHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 SW 74TH ST SUITE 411
SOUTH MIAMI FL
33143-5165
US

IV. Provider business mailing address

5901 SW 74TH ST SUITE 411
SOUTH MIAMI FL
33143-5165
US

V. Phone/Fax

Practice location:
  • Phone: 305-740-9688
  • Fax: 305-428-9521
Mailing address:
  • Phone: 305-740-9688
  • Fax: 305-428-9521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberSA8367
License Number StateFL

VIII. Authorized Official

Name: MELISSA BERRY BAETIONG
Title or Position: DIRECTOR
Credential: M.A., CCC-SLP
Phone: 305-740-9688