Provider Demographics
NPI:1770887143
Name:PRADA, MONICA (MS CCC)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:PRADA
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SW 159TH TER
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2250
Mailing Address - Country:US
Mailing Address - Phone:954-384-7155
Mailing Address - Fax:954-942-6941
Practice Address - Street 1:207 SW 159TH TER
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33326-2250
Practice Address - Country:US
Practice Address - Phone:954-384-7155
Practice Address - Fax:954-942-6941
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist