Provider Demographics
NPI:1417997792
Name:COLEMAN, SABRINA L (MA, CCC/SLP)
Entity Type:Individual
Prefix:MISS
First Name:SABRINA
Middle Name:L
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 LAKE VISTA CT
Mailing Address - Street 2:#300
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-6469
Mailing Address - Country:US
Mailing Address - Phone:407-677-4147
Mailing Address - Fax:
Practice Address - Street 1:2440 LAKE VISTA CT
Practice Address - Street 2:#300
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-6469
Practice Address - Country:US
Practice Address - Phone:407-677-4147
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7292235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8889317Medicaid