Provider Demographics
NPI:1073821245
Name:GANDARILLAS, BRIGETTE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRIGETTE
Middle Name:
Last Name:GANDARILLAS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 SW 16TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2112
Mailing Address - Country:US
Mailing Address - Phone:305-495-8106
Mailing Address - Fax:
Practice Address - Street 1:22840 OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:GOULDS
Practice Address - State:FL
Practice Address - Zip Code:33170-6340
Practice Address - Country:US
Practice Address - Phone:305-255-9561
Practice Address - Fax:305-255-2572
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8480235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist