Provider Demographics
NPI:1184509648
Name:SAMPAYO, RAFAEL BROWN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:BROWN
Last Name:SAMPAYO
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:RAFAEL
Other - Middle Name:BROWN
Other - Last Name:SAMPAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REBECCA SAMPAYO
Mailing Address - Street 1:4600 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-1943
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4600 RIVER RD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-1943
Practice Address - Country:US
Practice Address - Phone:646-314-2043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9757235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist