Provider Demographics
NPI:1447750260
Name:VEGA-VELASQUEZ, SADIE (MS, SLP)
Entity type:Individual
Prefix:MRS
First Name:SADIE
Middle Name:
Last Name:VEGA-VELASQUEZ
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:MS
Other - First Name:SADIE
Other - Middle Name:
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, SLP
Mailing Address - Street 1:6756 ORCHID DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2645
Mailing Address - Country:US
Mailing Address - Phone:305-409-3372
Mailing Address - Fax:
Practice Address - Street 1:1601 NW 12TH AVE
Practice Address - Street 2:5065
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-243-5706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8482235Z00000X
FLSA17235235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist