Provider Demographics
NPI:1386726867
Name:SALAZAR, ALEXANDRA SOFIA (MSSLP SA13588)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:SOFIA
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:MSSLP SA13588
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7355 NW 173RD DR APT 101
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-8423
Mailing Address - Country:US
Mailing Address - Phone:786-486-5184
Mailing Address - Fax:786-391-2963
Practice Address - Street 1:9500 NW 77TH AVE
Practice Address - Street 2:BAY 3
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-2530
Practice Address - Country:US
Practice Address - Phone:786-429-7713
Practice Address - Fax:786-391-2963
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 13588235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004269000Medicaid