Provider Demographics
NPI:1508064486
Name:ROQUE, SHAMIR I (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHAMIR
Middle Name:I
Last Name:ROQUE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CUIDAD JARDIN 1
Mailing Address - Street 2:ANIS 8
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-599-9869
Mailing Address - Fax:
Practice Address - Street 1:URB. PEREYO
Practice Address - Street 2:CALLE RAMON GOMEZ #1
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-547-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1373-22355S0801X
PR4384235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1373-2OtherTERAPISTA DEL HABLA