Provider Demographics
NPI:1316659287
Name:SNEAD, SALLY HALL (MED)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:HALL
Last Name:SNEAD
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 E HILLSBORO BLVD APT 738
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-4305
Mailing Address - Country:US
Mailing Address - Phone:804-399-9555
Mailing Address - Fax:
Practice Address - Street 1:1523 E HILLSBORO BLVD APT 738
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4305
Practice Address - Country:US
Practice Address - Phone:804-399-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001906235Z00000X
FLSA20030235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist