Provider Demographics
NPI:1003135070
Name:MOSES, YENTEL C (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:YENTEL
Middle Name:C
Last Name:MOSES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 VATICAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-4136
Mailing Address - Country:US
Mailing Address - Phone:954-494-5468
Mailing Address - Fax:954-989-7981
Practice Address - Street 1:5210 VATICAN AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-4136
Practice Address - Country:US
Practice Address - Phone:954-494-5468
Practice Address - Fax:954-989-7981
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist