MEDICARE: PRASHANTHI PENDEM M.SC. 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

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	:	1831524016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRASHANTHI PENDEM M.SC. CCC-SLP

Provider Business Mailing Address
First Line	:	1431 SIMPSON RD APT 56
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-4604
Country	:	US
Telephone Number	:	863-602-6209
Fax Number	:

Provider Business Practice Location Address
First Line	:	7004 TAVISTOCK LAKES BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7731
Country	:	US
Telephone Number	:	856-309-8508
Fax Number	:

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

Provider Enumeration Date	:	09/06/2013
Last Update Date	:	07/15/2022

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