Provider Demographics
NPI:1891363131
Name:FOULADI, MIRANDA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:FOULADI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:COFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:13506 SUMMERPORT VILLAGE PKWY STE 410
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-7366
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4705 S APOPKA VINELAND RD STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-3151
Practice Address - Country:US
Practice Address - Phone:407-905-9300
Practice Address - Fax:407-905-9309
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46003899A235Z00000X
FL20122235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist