Provider Demographics
NPI:1578015327
Name:STOKAR-KESSOCK, SHIRA (MS, CCC- SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHIRA
Middle Name:
Last Name:STOKAR-KESSOCK
Suffix:
Gender:F
Credentials:MS, CCC- SLP
Other - Prefix:MISS
Other - First Name:SHIRA
Other - Middle Name:MIRIAM
Other - Last Name:STOKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7320 ANDORRA PL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-4952
Mailing Address - Country:US
Mailing Address - Phone:201-410-3873
Mailing Address - Fax:
Practice Address - Street 1:7320 ANDORRA PL
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-4952
Practice Address - Country:US
Practice Address - Phone:201-410-3873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 14991235Z00000X
NJ41YS00758800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist