Provider Demographics
NPI:1497363634
Name:MUSCATO, MIRANDA NIKOLE (SLPD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:NIKOLE
Last Name:MUSCATO
Suffix:
Gender:
Credentials:SLPD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15223 EVERGREEN OAK LOOP
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-6429
Mailing Address - Country:US
Mailing Address - Phone:816-591-6214
Mailing Address - Fax:
Practice Address - Street 1:15223 EVERGREEN OAK LOOP
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-6429
Practice Address - Country:US
Practice Address - Phone:816-591-6214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16738235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist