Provider Demographics
NPI:1770828022
Name:OSUNFISAN, DANILDA LAVANDIER (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANILDA
Middle Name:LAVANDIER
Last Name:OSUNFISAN
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 1:4500 N STATE ROAD 7 STE 214
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5882
Mailing Address - Country:US
Mailing Address - Phone:954-557-6632
Mailing Address - Fax:
Practice Address - Street 1:4500 N STATE ROAD 7 STE 214
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319
Practice Address - Country:US
Practice Address - Phone:954-533-2226
Practice Address - Fax:954-765-6708
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011018661235Z00000X
FLSA15837235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022996600Medicaid