Provider Demographics
NPI:1447734009
Name:MASTROTA, ANTONIETTA LUCIA (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:ANTONIETTA
Middle Name:LUCIA
Last Name:MASTROTA
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:ANTONIETTA
Other - Middle Name:
Other - Last Name:MASTROTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:TONI MASTROTA
Mailing Address - Street 1:304 LAKE AVE APT 329
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6393
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2957 W STATE ROAD 434 STE 100
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4453
Practice Address - Country:US
Practice Address - Phone:407-960-4049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8796235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFD337ZMedicaid
FLSZ8796OtherFL DEPARTMENT OF HEALTH