Provider Demographics
NPI:1972954105
Name:SANCHEZ, DIANA CONSTANZA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:CONSTANZA
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 LAKEWOOD CIR S
Mailing Address - Street 2:HOUSE E
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5256
Mailing Address - Country:US
Mailing Address - Phone:954-993-1647
Mailing Address - Fax:
Practice Address - Street 1:5979 NW 151ST ST STE 208
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2446
Practice Address - Country:US
Practice Address - Phone:954-303-9335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16984235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist