Provider Demographics
NPI:1164104014
Name:ESPINOSA ORTIZ, SHAINE LEONOR
Entity Type:Individual
Prefix:
First Name:SHAINE
Middle Name:LEONOR
Last Name:ESPINOSA ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 SW 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2633
Mailing Address - Country:US
Mailing Address - Phone:305-505-8481
Mailing Address - Fax:
Practice Address - Street 1:2520 SW 99TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2633
Practice Address - Country:US
Practice Address - Phone:305-505-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst