MEDICARE: ANNA MARIE MAINIERO

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	SZ9733	FL

General Provider Information

NPI Number	:	1942813019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA MARIE MAINIERO

Provider Business Mailing Address
First Line	:	4707 W GANDY BLVD STE 3
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-3310
Country	:	US
Telephone Number	:	813-728-6601
Fax Number	:	813-354-4800

Provider Business Practice Location Address
First Line	:	4707 W GANDY BLVD STE 3
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-3310
Country	:	US
Telephone Number	:	813-728-6601
Fax Number	:	813-354-4800

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

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	08/28/2020

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Directions to “ ANNA MARIE MAINIERO ” Practice Location

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