Provider Demographics
NPI:1861146367
Name:RIVERO, SAMANTHA REN (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:REN
Last Name:RIVERO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2922 NW 130TH AVE APT 110
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3064
Mailing Address - Country:US
Mailing Address - Phone:305-467-7859
Mailing Address - Fax:
Practice Address - Street 1:3335 N UNIVERSITY DR STE 5
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2200
Practice Address - Country:US
Practice Address - Phone:954-442-9422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA21006235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist