Provider Demographics
NPI:1942268925
Name:SOBRAL, ELIANA MARIA CROUZEILLES (SPEECH-LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:ELIANA MARIA
Middle Name:CROUZEILLES
Last Name:SOBRAL
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13712 AMELIA POND DR
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-3114
Mailing Address - Country:US
Mailing Address - Phone:407-877-5631
Mailing Address - Fax:407-877-5635
Practice Address - Street 1:13712 AMELIA POND DR
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-3114
Practice Address - Country:US
Practice Address - Phone:407-877-5631
Practice Address - Fax:407-877-5635
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5558235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL679537496Medicaid
FL885537400Medicaid