Provider Demographics
NPI:1356852560
Name:PRUNETI, SANDY M (MACCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:M
Last Name:PRUNETI
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9102 DUCALE WAY APT 307
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-8165
Mailing Address - Country:US
Mailing Address - Phone:215-815-3263
Mailing Address - Fax:
Practice Address - Street 1:5100 CRESTHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-8618
Practice Address - Country:US
Practice Address - Phone:561-964-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-14
Last Update Date:2017-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist