Healthcare Provider Details

I. General information

NPI: 1346701497
Provider Name (Legal Business Name): SOPHIA NALLABELLI SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOPHIA GRETTENBERGER

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 CAPITAL MEDICAL BLVD
TALLAHASSEE FL
32308-4408
US

IV. Provider business mailing address

237 VALLEY VIEW CT
MONTICELLO FL
32344-7641
US

V. Phone/Fax

Practice location:
  • Phone: 850-294-3249
  • Fax:
Mailing address:
  • Phone: 385-539-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13513
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: