Provider Demographics
NPI:1982460721
Name:BRAVO, LEIDYS LILIE
Entity Type:Individual
Prefix:MS
First Name:LEIDYS
Middle Name:LILIE
Last Name:BRAVO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 S ROYAL POINCIANA BLVD APT 109
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6183
Mailing Address - Country:US
Mailing Address - Phone:786-839-8355
Mailing Address - Fax:
Practice Address - Street 1:249 S ROYAL POINCIANA BLVD APT 109
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-6183
Practice Address - Country:US
Practice Address - Phone:786-839-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI68962355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant