Provider Demographics
NPI:1053749127
Name:MAMEY, JOAN (SP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:MAMEY
Suffix:
Gender:F
Credentials:SP
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:FADEL
Other - Last Name:MAMEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SP
Mailing Address - Street 1:8213 SIMPKINS WAY
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940
Mailing Address - Country:US
Mailing Address - Phone:818-500-0016
Mailing Address - Fax:
Practice Address - Street 1:8213 SIMPKINS WAY
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:818-500-0016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-28
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 2880235Z00000X
FLSA12295235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP 2880OtherSPEECH-LANGUAGE PATHOLOGIST