Provider Demographics
NPI:1942758552
Name:MISRAHI, BRITTANY DEVINE (MS)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:DEVINE
Last Name:MISRAHI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17817 OLIVE OAK WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32820-2273
Mailing Address - Country:US
Mailing Address - Phone:847-533-2605
Mailing Address - Fax:
Practice Address - Street 1:2080 W EAU GALLIE BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3152
Practice Address - Country:US
Practice Address - Phone:407-694-3603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7807235Z00000X
FLSA16020235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA16020OtherLICENSE