Provider Demographics
NPI:1255004560
Name:ROSARIO TILLEY, SARAH ANNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:ROSARIO TILLEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ANNE
Other - Last Name:TILLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:733 DELANEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1321
Mailing Address - Country:US
Mailing Address - Phone:407-451-8267
Mailing Address - Fax:
Practice Address - Street 1:7975 LAKE UNDERHILL RD STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8205
Practice Address - Country:US
Practice Address - Phone:407-303-6733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14520235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist