Provider Demographics
NPI:1831634369
Name:SIORDIA, DEMETRIO (MED,MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:DEMETRIO
Middle Name:
Last Name:SIORDIA
Suffix:
Gender:M
Credentials:MED,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:PO BOX 90
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-0090
Mailing Address - Country:US
Mailing Address - Phone:956-377-0119
Mailing Address - Fax:
Practice Address - Street 1:601 E KELLY AVE
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-4905
Practice Address - Country:US
Practice Address - Phone:956-377-0119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist