Provider Demographics
NPI:1891049953
Name:BANCORA, CAROLINA (SLP)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:BANCORA
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 1:5979 NW 151ST ST
Mailing Address - Street 2:SUITE #208
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2400
Mailing Address - Country:US
Mailing Address - Phone:305-362-3300
Mailing Address - Fax:
Practice Address - Street 1:5979 NW 151ST ST
Practice Address - Street 2:SUITE 208
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2400
Practice Address - Country:US
Practice Address - Phone:305-362-3300
Practice Address - Fax:305-362-0202
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-28
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6076235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist