MEDICARE: GAYLE MERCADO 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	SA4923	FL

General Provider Information

NPI Number	:	1508073594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLE MERCADO M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	1289 NE 105TH ST
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1289 NE 105TH ST
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2105
Country	:	US
Telephone Number	:	305-893-2646
Fax Number	:

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	05/01/2008

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Directions to “ GAYLE MERCADO M.A. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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