Provider Demographics
NPI:1629422761
Name:ABREU, SHOUBERTE (MS)
Entity Type:Individual
Prefix:MS
First Name:SHOUBERTE
Middle Name:
Last Name:ABREU
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10040 NW 9TH STREET CIR APT 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5132
Mailing Address - Country:US
Mailing Address - Phone:305-747-3080
Mailing Address - Fax:
Practice Address - Street 1:10040 NW 9TH STREET CIR APT 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-5132
Practice Address - Country:US
Practice Address - Phone:305-747-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 247200000X, 252Y00000X
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No252Y00000XAgenciesEarly Intervention Provider Agency