Provider Demographics
NPI:1386893162
Name:CHERUBIN, WYNELLA (MA CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:WYNELLA
Middle Name:
Last Name:CHERUBIN
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1993 RIVER PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-4840
Mailing Address - Country:US
Mailing Address - Phone:321-217-7051
Mailing Address - Fax:
Practice Address - Street 1:7777 GLADES RD
Practice Address - Street 2:SUITE 215
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4194
Practice Address - Country:US
Practice Address - Phone:561-989-8595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist