MEDICARE: MS. KRISTEN M MENDOZA

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	SA21338	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	:	1811496920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTEN M MENDOZA

Provider Business Mailing Address
First Line	:	108 N COOPERS HAWK WAY
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-2312
Country	:	US
Telephone Number	:	386-717-3566
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 N COOPERS HAWK WAY
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-2312
Country	:	US
Telephone Number	:	386-717-3566
Fax Number	:

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

Provider Enumeration Date	:	02/04/2018
Last Update Date	:	12/17/2025

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