Provider Demographics
NPI:1184376386
Name:SUNCOAST PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:SUNCOAST PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:CARREIRA
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:MED CCC-SLP
Authorized Official - Phone:912-674-9776
Mailing Address - Street 1:16748 FAIRBOLT WAY
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-6031
Mailing Address - Country:US
Mailing Address - Phone:912-674-9776
Mailing Address - Fax:
Practice Address - Street 1:16748 FAIRBOLT WAY
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-6031
Practice Address - Country:US
Practice Address - Phone:912-674-9776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty