Provider Demographics
NPI:1902270465
Name:WALKER ANGEL, SISAN
Entity Type:Individual
Prefix:
First Name:SISAN
Middle Name:
Last Name:WALKER ANGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SISAN
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CF-SLP
Mailing Address - Street 1:8415 SW 107TH AVE
Mailing Address - Street 2:APR 356W
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4393
Mailing Address - Country:US
Mailing Address - Phone:305-815-3923
Mailing Address - Fax:
Practice Address - Street 1:8510 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4053
Practice Address - Country:US
Practice Address - Phone:305-266-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7254235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist