MEDICARE: REBECA FISIKELLI

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	SA11016	FL

General Provider Information

NPI Number	:	1356620769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECA FISIKELLI

Provider Business Mailing Address
First Line	:	5230 SW 101ST TER
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33328-4950
Country	:	US
Telephone Number	:	305-342-4044
Fax Number	:

Provider Business Practice Location Address
First Line	:	3335 N UNIVERSITY DR
Second Line	:	SUITE 5
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2200
Country	:	US
Telephone Number	:	954-442-9422
Fax Number	:

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

Provider Enumeration Date	:	08/16/2011
Last Update Date	:	08/16/2011

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Directions to “ REBECA FISIKELLI ” Practice Location

Language	Start Address	Practice Location

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