Provider Demographics
NPI:1811028541
Name:PENNELL, SARA DILUZIO (SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:DILUZIO
Last Name:PENNELL
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 1:1809 COLLEEN DR
Mailing Address - Street 2:
Mailing Address - City:BELLE ISLE
Mailing Address - State:FL
Mailing Address - Zip Code:32809-6873
Mailing Address - Country:US
Mailing Address - Phone:407-963-6687
Mailing Address - Fax:
Practice Address - Street 1:1809 COLLEEN DR
Practice Address - Street 2:
Practice Address - City:BELLE ISLE
Practice Address - State:FL
Practice Address - Zip Code:32809-6873
Practice Address - Country:US
Practice Address - Phone:407-963-6687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889625900Medicaid