Provider Demographics
NPI:1811306566
Name:SUNFLOWER SPEECH, PLLC.
Entity type:Organization
Organization Name:SUNFLOWER SPEECH, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:BORTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:561-651-9614
Mailing Address - Street 1:8127 MARIPOSA GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4632
Mailing Address - Country:US
Mailing Address - Phone:561-651-9614
Mailing Address - Fax:
Practice Address - Street 1:8127 MARIPOSA GROVE CIR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33411-4632
Practice Address - Country:US
Practice Address - Phone:561-651-9614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11638261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010805500Medicaid