Provider Demographics
NPI:1730653148
Name:AZERAD, GISELE DUCHER (SLP)
Entity type:Individual
Prefix:
First Name:GISELE
Middle Name:DUCHER
Last Name:AZERAD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 HERONS RUN DR APT 503
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1747
Mailing Address - Country:US
Mailing Address - Phone:941-685-8157
Mailing Address - Fax:
Practice Address - Street 1:1550 KILLINGSWORTH WAY
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-2175
Practice Address - Country:US
Practice Address - Phone:352-674-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2958235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist