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General NPI Number Information
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NPI Number | 1073839908
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Entity Type | Organization
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Legal Business Name | SUNSET SPEECH AND LANGUAGE PATHOLOGY, LLC
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Dates
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Enumeration Date | 04/16/2010
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Last Update Date | 05/31/2013
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Provider Practice Location Address
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Address Line | 5901 SW 74TH ST SUITE 411
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5165
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Country | US
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Telephone | 305-740-9688
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Fax | 305-428-9521
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Provider Business Mailing Address
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Address Line | 5901 SW 74TH ST SUITE 411
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5165
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Country | US
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Telephone | 305-740-9688
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Fax | 305-428-9521
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Authorized Official
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Title or Position | DIRECTOR
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Name | MELISSA BERRY BAETIONG
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Credential | M.A., CCC-SLP
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Telephone | 305-740-9688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | SA8367
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License Number State | FL
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