Provider Demographics
NPI:1306204292
Name:RESNICK, SHARI
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:
Last Name:RESNICK
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 1:4462 WINDERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2636
Mailing Address - Country:US
Mailing Address - Phone:407-296-9999
Mailing Address - Fax:307-852-3301
Practice Address - Street 1:4462 WINDERWOOD CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-2636
Practice Address - Country:US
Practice Address - Phone:407-296-9999
Practice Address - Fax:307-852-3301
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2065235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist