Provider Demographics
NPI:1295203636
Name:BERRIOS RODRIGUEZ, SHAIMIR
Entity Type:Individual
Prefix:
First Name:SHAIMIR
Middle Name:
Last Name:BERRIOS RODRIGUEZ
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 1:5707 SE 116TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-4327
Mailing Address - Country:US
Mailing Address - Phone:352-659-3334
Mailing Address - Fax:
Practice Address - Street 1:4709 SE 102ND PL UNIT 2-104
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-2939
Practice Address - Country:US
Practice Address - Phone:352-659-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-04
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA17357235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist