Provider Demographics
NPI:1710933759
Name:EUSTACE, DAWN MICHELLE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:MICHELLE
Last Name:EUSTACE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10064 SW 117TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-8521
Mailing Address - Country:US
Mailing Address - Phone:305-205-9565
Mailing Address - Fax:
Practice Address - Street 1:10064 SW 117TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-8521
Practice Address - Country:US
Practice Address - Phone:305-205-9565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 5117235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL884675800Medicaid