Provider Demographics
NPI:1275880957
Name:ROSAS-DIAZ, ELIZABETH (MS, CCC-SLP TSSLD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ROSAS-DIAZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP TSSLD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:ROSAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:33243 SAND CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-4518
Mailing Address - Country:US
Mailing Address - Phone:347-308-3716
Mailing Address - Fax:
Practice Address - Street 1:33243 SAND CREEK DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-4518
Practice Address - Country:US
Practice Address - Phone:347-308-3716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18352235Z00000X
NY027789-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist