Provider Demographics
NPI:1447382916
Name:COLANTINO, NANCY T (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:T
Last Name:COLANTINO
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 1:5020 GODDARD AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-1168
Mailing Address - Country:US
Mailing Address - Phone:407-299-1533
Mailing Address - Fax:407-295-5965
Practice Address - Street 1:5020 GODDARD AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-1168
Practice Address - Country:US
Practice Address - Phone:407-299-1533
Practice Address - Fax:407-295-5965
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6803235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist