Provider Demographics
NPI:1568910073
Name:SIO, ROXANNE MARIE
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:MARIE
Last Name:SIO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ROXANNE
Other - Middle Name:MARIE
Other - Last Name:SIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:615 NE 10TH ST APT 202
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2518
Mailing Address - Country:US
Mailing Address - Phone:305-282-6102
Mailing Address - Fax:
Practice Address - Street 1:1401 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2619
Practice Address - Country:US
Practice Address - Phone:954-728-1098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7808222Q00000X, 235Z00000X
FLSA15630222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1568910073Medicaid