MEDICARE: MRS. RONDA STAR SITNIK MA CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	13917	NC

General Provider Information

NPI Number	:	1023748746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RONDA STAR SITNIK MA CCC-SLP

Provider Business Mailing Address
First Line	:	4114 SHIPYARD BLVD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6155
Country	:	US
Telephone Number	:	910-343-8988
Fax Number	:	910-343-4144

Provider Business Practice Location Address
First Line	:	4114 SHIPYARD BLVD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6155
Country	:	US
Telephone Number	:	910-343-8988
Fax Number	:	910-242-4144

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2022
Last Update Date	:	06/15/2022

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