Provider Demographics
NPI:1114067311
Name:HOFFMAN, SHIRAH LYNN (MSCCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHIRAH
Middle Name:LYNN
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:SHIRAH
Other - Middle Name:LYNN
Other - Last Name:BENGSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4310 METRO PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-9416
Mailing Address - Country:US
Mailing Address - Phone:239-236-8784
Mailing Address - Fax:239-790-2624
Practice Address - Street 1:6430 PLANTATION PARK CT STE 200
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-4816
Practice Address - Country:US
Practice Address - Phone:239-215-1025
Practice Address - Fax:239-985-9386
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8875235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist