Provider Demographics
NPI:1346392834
Name:DE QUESADA, SANDRA BOSCH (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:BOSCH
Last Name:DE QUESADA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10760 SW 123RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-4633
Mailing Address - Country:US
Mailing Address - Phone:305-278-0118
Mailing Address - Fax:
Practice Address - Street 1:1790 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2992
Practice Address - Country:US
Practice Address - Phone:305-825-1664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 4886235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist