Provider Demographics
NPI:1831524016
Name:PENDEM, PRASHANTHI (MSC CCC-SLP)
Entity type:Individual
Prefix:
First Name:PRASHANTHI
Middle Name:
Last Name:PENDEM
Suffix:
Gender:F
Credentials:MSC CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 SIMPSON RD APT 56
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4604
Mailing Address - Country:US
Mailing Address - Phone:863-602-6209
Mailing Address - Fax:
Practice Address - Street 1:7004 TAVISTOCK LAKES BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7731
Practice Address - Country:US
Practice Address - Phone:856-309-8508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist