Healthcare Provider Details

I. General information

NPI: 1356251292
Provider Name (Legal Business Name): STEPHANIE M ROSENDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 CALLE SANTA CRUZ
BAYAMON PR
00961-6900
US

IV. Provider business mailing address

COOP. VILLA KENNEDY APT 241 BUILDING 14
SAN JUAN PR
00915
US

V. Phone/Fax

Practice location:
  • Phone: 787-301-0238
  • Fax:
Mailing address:
  • Phone: 787-629-9269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5177
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: