Provider Demographics
NPI:1639459043
Name:SHILLING, MARISA BERYL (MS)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:BERYL
Last Name:SHILLING
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 1:1426 SUNSHINE DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8777
Mailing Address - Country:US
Mailing Address - Phone:561-351-4103
Mailing Address - Fax:
Practice Address - Street 1:1426 SUNSHINE DR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8777
Practice Address - Country:US
Practice Address - Phone:561-351-4103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist