=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194196592
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DYSPHAGIA MANAGEMENT SYSTEMS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2015
-----------------------------------------------------
Last Update Date | 02/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5763 WILENA PL
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34238-1710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-320-8930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5763 WILENA PL
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34238-1710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-320-8930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CAROL GHIGLIERI WINCHESTER
-----------------------------------------------------
Credential | MS SLP CCC
-----------------------------------------------------
Telephone | 941-320-8930
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number | SA2829
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------