MEDICARE: MRS. DENISE BRAVO 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	SA 7263	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568488393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISE BRAVO M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	2735 CLINTON HEIGHTS CT
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-6379
Country	:	US
Telephone Number	:	407-673-4978
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 E COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-5200
Country	:	US
Telephone Number	:	407-898-5060
Fax Number	:

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/08/2007

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