Provider Demographics
NPI:1083062335
Name:SHOQUIST, ANDREA CAROLINA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CAROLINA
Last Name:SHOQUIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:CAROLINA
Other - Last Name:BERMUDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:16465 HENDERSON PASS APT 422
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3204
Mailing Address - Country:US
Mailing Address - Phone:210-800-4936
Mailing Address - Fax:
Practice Address - Street 1:1635 NE LOOP 410 STE 600
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1619
Practice Address - Country:US
Practice Address - Phone:210-457-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106002235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist