Provider Demographics
NPI:1245738079
Name:FERNANDEZ, ANTHONY MICHAEL (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5117 TWELVEPOLE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5877
Mailing Address - Country:US
Mailing Address - Phone:786-512-3113
Mailing Address - Fax:
Practice Address - Street 1:10320 DURANT RD STE 109
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6466
Practice Address - Country:US
Practice Address - Phone:919-234-7770
Practice Address - Fax:855-978-2208
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30003672235Z00000X
FLSA18656235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist