MEDICARE: STEPHANIE DESILET MS, 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	SA13992	FL

General Provider Information

NPI Number	:	1861861460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE DESILET MS, CCC-SLP

Provider Business Mailing Address
First Line	:	1463 NECTARINE ST
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-3027
Country	:	US
Telephone Number	:	904-491-6660
Fax Number	:	904-372-0496

Provider Business Practice Location Address
First Line	:	850 INDIGO ST
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-3763
Country	:	US
Telephone Number	:	904-635-3179
Fax Number	:	904-372-0496

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

Provider Enumeration Date	:	09/24/2015
Last Update Date	:	07/21/2024

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