MEDICARE: MRS. BRIGETTE GANDARILLAS M.S., C.C.C.-S.L.P

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	SA8480	FL

General Provider Information

NPI Number	:	1073821245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRIGETTE GANDARILLAS M.S., C.C.C.-S.L.P

Provider Business Mailing Address
First Line	:	2120 SW 16TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-2112
Country	:	US
Telephone Number	:	305-495-8106
Fax Number	:

Provider Business Practice Location Address
First Line	:	22840 OLD DIXIE HWY
Second Line	:
City	:	GOULDS
State	:	FL
Zip	:	33170-6340
Country	:	US
Telephone Number	:	305-255-9561
Fax Number	:	305-255-2572

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

Provider Enumeration Date	:	09/21/2010
Last Update Date	:	09/21/2010

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