Provider Demographics
NPI:1205226347
Name:ROMAN, SHIRLEY IVETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:IVETTE
Last Name:ROMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 SPRING PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4801
Mailing Address - Country:US
Mailing Address - Phone:787-412-1708
Mailing Address - Fax:
Practice Address - Street 1:AVE PONCE DE LEON
Practice Address - Street 2:HOSPITAL AUXILIO MUTUO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-3907
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13509-I208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice