Provider Demographics
NPI:1003141177
Name:DE LOS SANTOS, SHARA RENEE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHARA
Middle Name:RENEE
Last Name:DE LOS SANTOS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:SHARA
Other - Middle Name:RENNE
Other - Last Name:DE LA GARZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA SLP
Mailing Address - Street 1:2034 DAYLIGHT CRST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5927
Mailing Address - Country:US
Mailing Address - Phone:956-286-1174
Mailing Address - Fax:
Practice Address - Street 1:1020 CENTRAL PKWY S
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5021
Practice Address - Country:US
Practice Address - Phone:121-079-8227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104470235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist