MEDICARE: SUMMER LYNN STAVREVSKI MS 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	22845	FL

General Provider Information

NPI Number	:	1588550677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMMER LYNN STAVREVSKI MS CCC-SLP

Provider Business Mailing Address
First Line	:	2911 LOS GATOS DR
Second Line	:
City	:	BELLEAIR BLUFFS
State	:	FL
Zip	:	33770-1704
Country	:	US
Telephone Number	:	727-481-5458
Fax Number	:

Provider Business Practice Location Address
First Line	:	4439 ROWAN RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-6198
Country	:	US
Telephone Number	:	727-834-5380
Fax Number	:

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

Provider Enumeration Date	:	06/16/2025
Last Update Date	:	06/16/2025

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