Provider Demographics
NPI:1750820130
Name:CHIONG, YARELIS (SLP)
Entity Type:Individual
Prefix:
First Name:YARELIS
Middle Name:
Last Name:CHIONG
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 1:19572 NW 55TH CIRCLE PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-6185
Mailing Address - Country:US
Mailing Address - Phone:305-498-4097
Mailing Address - Fax:
Practice Address - Street 1:5580 W 16TH AVE
Practice Address - Street 2:SUITE 201-202
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2189
Practice Address - Country:US
Practice Address - Phone:305-445-6264
Practice Address - Fax:305-967-8442
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7988235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist