Provider Demographics
NPI:1295034049
Name:DUARTE, GLADYS D
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:D
Last Name:DUARTE
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 1:10604 FAIRFIELD VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-5079
Mailing Address - Country:US
Mailing Address - Phone:813-968-4861
Mailing Address - Fax:
Practice Address - Street 1:13139 W LINEBAUGH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4498
Practice Address - Country:US
Practice Address - Phone:813-932-3013
Practice Address - Fax:813-932-3016
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FLSI 14162355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist