Provider Demographics
NPI:1528377223
Name:BOIARDT, MARTHA ELENA (MS)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ELENA
Last Name:BOIARDT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 940132
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-0132
Mailing Address - Country:US
Mailing Address - Phone:305-998-6084
Mailing Address - Fax:305-503-9284
Practice Address - Street 1:14310 SW 8TH ST
Practice Address - Street 2:#940132
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33194-3135
Practice Address - Country:US
Practice Address - Phone:305-998-6084
Practice Address - Fax:305-503-9284
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11066235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002844200Medicaid