Healthcare Provider Details

I. General information

NPI: 1093625113
Provider Name (Legal Business Name): ASHLEY ALONSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 EXECUTIVE PARK DR STE 300
WESTON FL
33331-3646
US

IV. Provider business mailing address

10760 CAMERON CT APT 108
DAVIE FL
33324-4178
US

V. Phone/Fax

Practice location:
  • Phone: 954-353-8777
  • Fax:
Mailing address:
  • Phone: 954-540-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA24179
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: