Provider Demographics
NPI:1760540256
Name:AXELRAD, MEESHA TOBI
Entity Type:Individual
Prefix:MS
First Name:MEESHA
Middle Name:TOBI
Last Name:AXELRAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8105 SEVERN DR APT C
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-8536
Mailing Address - Country:US
Mailing Address - Phone:561-955-5437
Mailing Address - Fax:
Practice Address - Street 1:9291 GLADES RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3959
Practice Address - Country:US
Practice Address - Phone:561-955-5437
Practice Address - Fax:561-483-7044
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4342235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist