Provider Demographics
NPI:1114782372
Name:FERNANDEZ, ALEXANDRA DANIELLE
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:DANIELLE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 NW 105TH LN
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-1044
Mailing Address - Country:US
Mailing Address - Phone:954-296-5166
Mailing Address - Fax:
Practice Address - Street 1:5800 NW 66TH TER
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2166
Practice Address - Country:US
Practice Address - Phone:954-296-5166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist