Organization
FL MC SPROUT 1, LLC
Active
Other names
Elemy
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW NEIDICH (VICE PRESIDENT, NETWORK OPERATIONS)
(917) 648-3846
Entity
Organization
Contact information
Practice address
501 E KENNEDY BLVD, TAMPA, FL 33602-5237
(561) 235-7613
Mailing address
6303 BLUE LAGOON DR STE 400, MIAMI, FL 33126-6040
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
12/10/2021
Last updated
12/10/2021
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