MEDICARE: MS. TANYA FERNANDEZ 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 7801	FL

General Provider Information

NPI Number	:	1659419141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TANYA FERNANDEZ CCC-SLP

Provider Business Mailing Address
First Line	:	11734 SUMMER SPRINGS DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-4074
Country	:	US
Telephone Number	:	813-244-1045
Fax Number	:

Provider Business Practice Location Address
First Line	:	11734 SUMMER SPRINGS DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-4074
Country	:	US
Telephone Number	:	813-244-1045
Fax Number	:

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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