MEDICARE: MRS. ANNELYSE CRUZE MA, 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
2	235Z00000X	Speech-Language Pathologist	14349	FL

General Provider Information

NPI Number	:	1861039877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNELYSE CRUZE MA, CCC-SLP

Provider Business Mailing Address
First Line	:	936 WINDWARD WAY
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080-6182
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 HILDEN RD STE 113
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32081-8401
Country	:	US
Telephone Number	:	904-652-5408
Fax Number	:

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

Provider Enumeration Date	:	12/09/2019
Last Update Date	:	12/09/2019

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Directions to “ MRS. ANNELYSE CRUZE MA, CCC-SLP” Practice Location

Language	Start Address	Practice Location

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