Provider Demographics
NPI:1497363634
Name:MUSCATO, MIRANDA NIKOLE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:NIKOLE
Last Name:MUSCATO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 SCENIC VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6109
Mailing Address - Country:US
Mailing Address - Phone:816-591-6214
Mailing Address - Fax:
Practice Address - Street 1:11301 SCENIC VISTA DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6109
Practice Address - Country:US
Practice Address - Phone:816-591-6214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16738235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist