MEDICARE: DIANE PETERS M.A.,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	SA7861	FL

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	:	1942416730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE PETERS M.A.,CCC-SLP

Provider Business Mailing Address
First Line	:	790 NW 107TH AVE STE 209
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33172-3158
Country	:	US
Telephone Number	:	786-512-4793
Fax Number	:	786-441-4413

Provider Business Practice Location Address
First Line	:	790 NW 107TH AVE STE 209
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33172-3158
Country	:	US
Telephone Number	:	786-512-4793
Fax Number	:	786-441-4413

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/31/2020

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