Provider Demographics
NPI:1164710141
Name:SENEA, SHARI LYNN (HAS)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:LYNN
Last Name:SENEA
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1452 MYRTLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-4215
Mailing Address - Country:US
Mailing Address - Phone:386-590-7217
Mailing Address - Fax:
Practice Address - Street 1:109 HOWARD ST E
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-3206
Practice Address - Country:US
Practice Address - Phone:386-362-5452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4493237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL610275100Medicaid