Provider Demographics
NPI:1902190085
Name:MALTBY, VANESSA PEREZ (MA)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:PEREZ
Last Name:MALTBY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9370 SW 72ND ST STE A213
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-5452
Mailing Address - Country:US
Mailing Address - Phone:305-934-2689
Mailing Address - Fax:
Practice Address - Street 1:9370 SW 72ND ST STE A213
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5452
Practice Address - Country:US
Practice Address - Phone:305-934-2689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11562235Z00000X
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist