Basic Information
| Provider Information | |||||||||
| NPI: | 1003291592 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOLIORADAKIS | ||||||||
| FirstName: | ALEXANDRA | ||||||||
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| Credential: | MS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3507 ROSEWATER DR | ||||||||
| Address2: | |||||||||
| City: | HOLIDAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346915109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275058132 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1825 S PINELLAS AVE STE 105 | ||||||||
| Address2: | |||||||||
| City: | TARPON SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346891948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275058132 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2015 | ||||||||
| LastUpdateDate: | 09/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA10582 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.