Provider Demographics
NPI:1760883128
Name:DELGADO, ANDREA CRISTINA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CRISTINA
Last Name:DELGADO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:CRISTINA
Other - Last Name:BLANCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14291 SW 120TH ST
Mailing Address - Street 2:SUITE #103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7286
Mailing Address - Country:US
Mailing Address - Phone:305-385-0168
Mailing Address - Fax:305-385-0182
Practice Address - Street 1:14291 SW 120TH ST
Practice Address - Street 2:SUITE #103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186
Practice Address - Country:US
Practice Address - Phone:305-385-0168
Practice Address - Fax:305-385-0182
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013100600Medicaid