Provider Demographics
NPI:1063568939
Name:SPERA, JOANNE (MS)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:SPERA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 BANCHORY RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4502
Mailing Address - Country:US
Mailing Address - Phone:917-692-1921
Mailing Address - Fax:
Practice Address - Street 1:2910 BANCHORY RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4502
Practice Address - Country:US
Practice Address - Phone:917-692-1921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR037372-11041C0700X
NY011298-1235Z00000X
FLSA10686235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002957700Medicaid