Provider Demographics
NPI:1932337367
Name:MALDONADO, JOYCE (SLPA)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 SHELDON RD
Mailing Address - Street 2:APT 2306
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-6122
Mailing Address - Country:US
Mailing Address - Phone:786-266-1637
Mailing Address - Fax:
Practice Address - Street 1:6210 SHELDON RD
Practice Address - Street 2:APT 2306
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-6122
Practice Address - Country:US
Practice Address - Phone:786-266-1637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI 16792355S0801X
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSI1679OtherSLPA LICENSE