Provider Demographics
NPI:1558499368
Name:SUPERFINE, DONALD MARK (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:MARK
Last Name:SUPERFINE
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 BLENHEM CT
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-3935
Mailing Address - Country:US
Mailing Address - Phone:813-961-7996
Mailing Address - Fax:
Practice Address - Street 1:1239 BLENHEM CT
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-3935
Practice Address - Country:US
Practice Address - Phone:813-961-7996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA740235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist