Provider Demographics
NPI:1649438896
Name:MIRANDA, EMILY ROBERTSON (SLPA, ITDS)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ROBERTSON
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:SLPA, ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8212 N EMPIRE AVE
Mailing Address - Street 2:
Mailing Address - City:CITRUS SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34433-4959
Mailing Address - Country:US
Mailing Address - Phone:407-404-1368
Mailing Address - Fax:
Practice Address - Street 1:315 NE 10TH AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4456
Practice Address - Country:US
Practice Address - Phone:352-795-7006
Practice Address - Fax:352-795-7008
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FLSI 12592355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist