Healthcare Provider Details

I. General information

NPI: 1982995668
Provider Name (Legal Business Name): CYNTHIA ANN DOMINGUEZ M.S. CFY-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 EXECUTIVE PARK DR SUITE 4
WESTON FL
33331-3651
US

IV. Provider business mailing address

4179 DERBY DR
DAVIE FL
33330-4316
US

V. Phone/Fax

Practice location:
  • Phone: 786-236-6590
  • Fax:
Mailing address:
  • Phone: 786-236-6590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ4993
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: