MEDICARE: NICOLE RENEE SEDAN M.S., 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	SZ4418	FL

General Provider Information

NPI Number	:	1831377027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE RENEE SEDAN M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	4017 SW KAMSLER ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-3018
Country	:	US
Telephone Number	:	772-579-0018
Fax Number	:

Provider Business Practice Location Address
First Line	:	4017 SW KAMSLER ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-3018
Country	:	US
Telephone Number	:	772-579-0018
Fax Number	:

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

Provider Enumeration Date	:	02/10/2008
Last Update Date	:	03/02/2012

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