Provider Demographics
NPI:1831496587
Name:FERNANDEZ, PAULA ANNE (MED SLP)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:ANNE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MED SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SHELBY RD
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-2627
Mailing Address - Country:US
Mailing Address - Phone:704-232-0057
Mailing Address - Fax:
Practice Address - Street 1:185 CHARLOIS BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1521
Practice Address - Country:US
Practice Address - Phone:336-725-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3374235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist