MEDICARE: SOUTH FLORIDA SPEECH AND HEARING REHABILITATION CENTER INC

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	SA10904	FL

General Provider Information

NPI Number	:	1396024204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA SPEECH AND HEARING REHABILITATION CENTER INC

Provider Business Mailing Address
First Line	:	4920 SW 64TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-6142
Country	:	US
Telephone Number	:	786-301-0554
Fax Number	:

Provider Business Practice Location Address
First Line	:	4920 SW 64TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-6142
Country	:	US
Telephone Number	:	786-301-0554
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	SOFIA LAGO
Credential	:	SLP
Telephone Number	:	786-301-0554

Provider Enumeration Date	:	08/09/2011
Last Update Date	:	08/09/2011

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