MEDICARE: ELENA BENNARDO 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	14068188
2	235Z00000X	Speech-Language Pathologist	SA14198	FL
3	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1457751943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA BENNARDO M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	2502 DEPAUW AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-5029
Country	:	US
Telephone Number	:	561-306-3292
Fax Number	:

Provider Business Practice Location Address
First Line	:	7205 ALOMA AVE
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-7101
Country	:	US
Telephone Number	:	321-972-3960
Fax Number	:

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

Provider Enumeration Date	:	09/03/2014
Last Update Date	:	03/03/2023

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