Provider Demographics
NPI:1609219948
Name:DUARTE, AMANDA LEONE (SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEONE
Last Name:DUARTE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8951 N NEW RIVER CANAL RD
Mailing Address - Street 2:#4B
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3832
Mailing Address - Country:US
Mailing Address - Phone:954-382-5254
Mailing Address - Fax:
Practice Address - Street 1:5190 NW 167TH ST
Practice Address - Street 2:SUITE 117
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-6328
Practice Address - Country:US
Practice Address - Phone:305-517-3047
Practice Address - Fax:305-517-3523
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12054235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist