MEDICARE: MS. SHARON BRADY CCC-SLP/L

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	17594	FL
2	235Z00000X	Speech-Language Pathologist	22002639	IN

General Provider Information

NPI Number	:	1396902771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON BRADY CCC-SLP/L

Provider Business Mailing Address
First Line	:	205 BEAUREGARD STREET
Second Line	:
City	:	LAKE PLACID
State	:	FL
Zip	:	33852
Country	:	US
Telephone Number	:	352-942-9827
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 BEAUREGARD ST
Second Line	:
City	:	LAKE PLACID
State	:	FL
Zip	:	33852-9480
Country	:	US
Telephone Number	:	352-942-9827
Fax Number	:

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

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	11/14/2019

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