MEDICARE: ANDREA BRAVERMAN 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	06001	MD

General Provider Information

NPI Number	:	1881165348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA BRAVERMAN M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	105 SEYMOUR AVE
Second Line	:
City	:	ST MICHAELS
State	:	MD
Zip	:	21663-2931
Country	:	US
Telephone Number	:	410-443-1914
Fax Number	:

Provider Business Practice Location Address
First Line	:	631 MAIN ST
Second Line	:
City	:	CHURCH HILL
State	:	MD
Zip	:	21623-1201
Country	:	US
Telephone Number	:	410-556-6103
Fax Number	:	410-556-6035

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

Provider Enumeration Date	:	12/10/2018
Last Update Date	:	12/10/2018

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Directions to “ ANDREA BRAVERMAN M.S. CCC-SLP” Practice Location

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