Provider Demographics
NPI:1780841635
Name:SHETROMPF, ANGELA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:SHETROMPF
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:SHETROMPF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:819 SW 147 AV
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2361
Mailing Address - Country:US
Mailing Address - Phone:954-709-5403
Mailing Address - Fax:954-589-1475
Practice Address - Street 1:819 SW 147 AV
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-2361
Practice Address - Country:US
Practice Address - Phone:954-709-5403
Practice Address - Fax:954-589-1475
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10362235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001470600Medicaid