Healthcare Provider Details

I. General information

NPI: 1942679170
Provider Name (Legal Business Name): PEDIATRIC FEEDING AND SWALLOWING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 1ST ST W
TIERRA VERDE FL
33715-1702
US

IV. Provider business mailing address

137 1ST ST W
TIERRA VERDE FL
33715-1702
US

V. Phone/Fax

Practice location:
  • Phone: 727-317-7655
  • Fax: 727-279-4977
Mailing address:
  • Phone: 727-317-7655
  • Fax: 727-279-4977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA14043
License Number StateFL

VIII. Authorized Official

Name: MRS. JOAN COMRIE
Title or Position: OWNER
Credential: M.S. CCC-SLP
Phone: 727-317-7655