MEDICARE: SUSAN WEISMAN MALCA

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	SA 6153	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	:	1992895940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN WEISMAN MALCA

Provider Business Mailing Address
First Line	:	4301 S FLAMINGO RD STE 101
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33330-1902
Country	:	US
Telephone Number	:	954-604-4568
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 S FLAMINGO RD STE 101
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33330-1902
Country	:	US
Telephone Number	:	954-312-3449
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	02/14/2022

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Directions to “ SUSAN WEISMAN MALCA ” Practice Location

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