Provider Demographics
NPI:1750625315
Name:CACCIATORE, SARA ER (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ER
Last Name:CACCIATORE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1382 LANDRY CIR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-2843
Mailing Address - Country:US
Mailing Address - Phone:321-961-5211
Mailing Address - Fax:
Practice Address - Street 1:1382 LANDRY CIR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-2843
Practice Address - Country:US
Practice Address - Phone:321-961-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11177235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist