Provider Demographics
NPI:1275924946
Name:BYRD, NANCY SORRENTINO (MED CCC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:SORRENTINO
Last Name:BYRD
Suffix:
Gender:F
Credentials:MED CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 CAVE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-5721
Mailing Address - Country:US
Mailing Address - Phone:830-998-3804
Mailing Address - Fax:830-392-0535
Practice Address - Street 1:254 CAVE CREEK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5721
Practice Address - Country:US
Practice Address - Phone:830-998-3804
Practice Address - Fax:830-392-0535
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14002235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist