Provider Demographics
NPI:1295876746
Name:MOUSSIGNAC, ANTONY A
Entity type:Individual
Prefix:
First Name:ANTONY
Middle Name:A
Last Name:MOUSSIGNAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7760 NW 45TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5708
Mailing Address - Country:US
Mailing Address - Phone:954-336-1375
Mailing Address - Fax:754-223-7061
Practice Address - Street 1:7760 NW 45TH ST
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351
Practice Address - Country:US
Practice Address - Phone:954-336-1375
Practice Address - Fax:754-223-7061
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10794235Z00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766770100Medicaid