Provider Demographics
NPI:1164298352
Name:ZURITA, BREANNA SHANTEL
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:SHANTEL
Last Name:ZURITA
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 1:4401 W KNOX ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3612
Mailing Address - Country:US
Mailing Address - Phone:813-999-6051
Mailing Address - Fax:
Practice Address - Street 1:6100 LAKE ELLENOR DR STE 261
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4638
Practice Address - Country:US
Practice Address - Phone:407-968-7807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL65832355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty