Provider Demographics
NPI:1831305374
Name:MARCELIN, REGINE
Entity Type:Individual
Prefix:
First Name:REGINE
Middle Name:
Last Name:MARCELIN
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 1:11824 SW 107TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3966
Mailing Address - Country:US
Mailing Address - Phone:305-446-1098
Mailing Address - Fax:305-446-1638
Practice Address - Street 1:401 MIRACLE MILE
Practice Address - Street 2:SUITE 403
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-281-5887
Practice Address - Fax:786-360-3805
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811857400Medicaid