Provider Demographics
NPI:1700191756
Name:SILLS BUTT, MELODY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:
Last Name:SILLS BUTT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 SW 163RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4454
Mailing Address - Country:US
Mailing Address - Phone:954-770-6666
Mailing Address - Fax:
Practice Address - Street 1:1946 SW 163RD AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4454
Practice Address - Country:US
Practice Address - Phone:954-770-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-15
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7901235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA7901OtherFLORIDA STATE LICENSE