Provider Demographics
NPI:1528320801
Name:MADI, DABARASH (MS-CCC-SLP)
Entity type:Individual
Prefix:
First Name:DABARASH
Middle Name:
Last Name:MADI
Suffix:
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4783 FRUITVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1815
Mailing Address - Country:US
Mailing Address - Phone:941-321-8000
Mailing Address - Fax:
Practice Address - Street 1:4783 FRUITVILLE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-1815
Practice Address - Country:US
Practice Address - Phone:941-321-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41SY00686700235Z00000X
FLSA11014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist