MEDICARE: DANIELA SODRE

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	SA12341	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578698346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELA SODRE

Provider Business Mailing Address
First Line	:	10014 N DALE MABRY HWY STE C-100
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-4426
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2565 N TOLEDO BLADE BLVD
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34289-9306
Country	:	US
Telephone Number	:	800-892-0640
Fax Number	:

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	08/20/2018

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Directions to “ DANIELA SODRE ” Practice Location

Language	Start Address	Practice Location

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