Provider Demographics
NPI:1558584995
Name:CENTOFANTI, MELISSA BARI (MS, CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:BARI
Last Name:CENTOFANTI
Suffix:
Gender:F
Credentials:MS, CCC SLP
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:BARI
Other - Last Name:SEAMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC SLP
Mailing Address - Street 1:14200 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-3073
Mailing Address - Country:US
Mailing Address - Phone:954-370-0610
Mailing Address - Fax:954-596-7753
Practice Address - Street 1:447 NW 73RD AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1608
Practice Address - Country:US
Practice Address - Phone:954-583-7383
Practice Address - Fax:954-583-7388
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8137235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist