Provider Demographics
NPI:1063770675
Name:SIGURDSSON, GUDNY HILDUR (S,LPA)
Entity type:Individual
Prefix:
First Name:GUDNY
Middle Name:HILDUR
Last Name:SIGURDSSON
Suffix:
Gender:F
Credentials:S,LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3523 BALLASTONE DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-8068
Mailing Address - Country:US
Mailing Address - Phone:407-618-3299
Mailing Address - Fax:
Practice Address - Street 1:5807 ARGERIAN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33545-4151
Practice Address - Country:US
Practice Address - Phone:813-973-9068
Practice Address - Fax:866-542-4710
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI20532355S0801X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist