Provider Demographics
NPI:1023554698
Name:LAMB, DEANNA CARREIRA (MED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:CARREIRA
Last Name:LAMB
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:MS
Other - First Name:DEANNA
Other - Middle Name:CAROL
Other - Last Name:CARREIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED CCC-SLP
Mailing Address - Street 1:16748 FAIRBOLT WAY
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-6031
Mailing Address - Country:US
Mailing Address - Phone:912-674-9776
Mailing Address - Fax:813-264-0768
Practice Address - Street 1:6508 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4022
Practice Address - Country:US
Practice Address - Phone:813-963-6923
Practice Address - Fax:813-264-0768
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7932235Z00000X
FLSA16009235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019687200Medicaid