Provider Demographics
NPI:1023743226
Name:PANMUNIN, TYLER (CCC-SLP)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:PANMUNIN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:TYLER
Other - Middle Name:
Other - Last Name:PAJARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1239 E NEWPORT CENTER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-7711
Mailing Address - Country:US
Mailing Address - Phone:754-444-3707
Mailing Address - Fax:
Practice Address - Street 1:1239 E NEWPORT CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-7711
Practice Address - Country:US
Practice Address - Phone:754-444-3707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA17748235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist