Provider Demographics
NPI:1487840625
Name:SOUEIDAN, NATALIE PUGH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:PUGH
Last Name:SOUEIDAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:6086 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-3709
Mailing Address - Country:US
Mailing Address - Phone:813-541-8631
Mailing Address - Fax:
Practice Address - Street 1:18115 N US HIGHWAY 41 STE 800
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-6475
Practice Address - Country:US
Practice Address - Phone:813-848-0341
Practice Address - Fax:813-540-8271
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FLSA 9744235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist