Provider Demographics
NPI:1982327235
Name:HYMAN, ANTWIWA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANTWIWA
Middle Name:
Last Name:HYMAN
Suffix:
Gender:F
Credentials: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 1:117 MILLENIA DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-0252
Mailing Address - Country:US
Mailing Address - Phone:904-472-1431
Mailing Address - Fax:
Practice Address - Street 1:117 MILLENIA DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-0252
Practice Address - Country:US
Practice Address - Phone:904-472-1431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16534235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist