Provider Demographics
NPI:1154012508
Name:BAEZ, ADDHAROSSIE CHARY
Entity type:Individual
Prefix:MS
First Name:ADDHAROSSIE
Middle Name:CHARY
Last Name:BAEZ
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 1:7751 NW 107TH AVE APT 518
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4055
Mailing Address - Country:US
Mailing Address - Phone:787-607-9622
Mailing Address - Fax:
Practice Address - Street 1:7751 NW 107TH AVE APT 518
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4055
Practice Address - Country:US
Practice Address - Phone:787-607-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL61952355S0801X
FL11400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant