MEDICARE: MS. NICOLE MAE BROWN CF-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		FL

General Provider Information

NPI Number	:	1194073700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE MAE BROWN CF-SLP

Provider Business Mailing Address
First Line	:	4961 SW 94TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-6423
Country	:	US
Telephone Number	:	305-609-3409
Fax Number	:

Provider Business Practice Location Address
First Line	:	4961 SW 94TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-6423
Country	:	US
Telephone Number	:	305-609-3409
Fax Number	:

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

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	08/29/2012

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