Provider Demographics
NPI:1518176114
Name:SUAREZ, SHIRLEY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:A
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 PONCE DE LEON BLVD.
Mailing Address - Street 2:SUITE 280
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2110
Mailing Address - Country:US
Mailing Address - Phone:305-667-4101
Mailing Address - Fax:305-726-0084
Practice Address - Street 1:4601 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 280
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2111
Practice Address - Country:US
Practice Address - Phone:305-667-4101
Practice Address - Fax:305-726-0084
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5598103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist