MEDICARE: VATNA PHIZEME

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	SA23992	FL

General Provider Information

NPI Number	:	1487589982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VATNA PHIZEME

Provider Business Mailing Address
First Line	:	1483 SW BOUGAINVILLEA AVE
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-7302
Country	:	US
Telephone Number	:	772-336-6928
Fax Number	:	772-336-6929

Provider Business Practice Location Address
First Line	:	1483 SW BOUGAINVILLEA AVE
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-7302
Country	:	US
Telephone Number	:	772-336-6928
Fax Number	:	772-336-6929

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

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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Directions to “ VATNA PHIZEME ” Practice Location

Language	Start Address	Practice Location

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