MEDICARE: MRS. CYNTHIA SMITH M.A, CCC-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	SA9126	FL

General Provider Information

NPI Number	:	1396916391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA SMITH M.A, CCC-SLP

Provider Business Mailing Address
First Line	:	228 PONTE VEDRA PARK DR
Second Line	:	SUITE 800
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-6613
Country	:	US
Telephone Number	:	904-280-0081
Fax Number	:	904-280-7680

Provider Business Practice Location Address
First Line	:	228 PONTE VEDRA PARK DR
Second Line	:	SUITE 800
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-6613
Country	:	US
Telephone Number	:	904-280-0081
Fax Number	:	904-280-7680

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

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	03/18/2008

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Directions to “ MRS. CYNTHIA SMITH M.A, CCC-SLP” Practice Location

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