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General NPI Number Information
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NPI Number | 1134178924
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Entity Type | Individual
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Provider Name | SANDRA TIBALDEO MS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 09/07/2010
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Provider Practice Location Address
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Address Line | 8481 SW 167TH TER
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City | PALMETTO BAY
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State | FL
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Zip | 33157-0401
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Country | US
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Telephone | 786-271-8964
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Fax | 800-826-9197
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Provider Business Mailing Address
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Address Line | 8481 SW 167TH TER
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City | PALMETTO BAY
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State | FL
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Zip | 33157-0401
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Country | US
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Telephone | 786-271-8964
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Fax | 800-826-9197
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA6310
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License Number State | FL
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