Provider Demographics
NPI:1790543429
Name:NUNEZ GOMEZ, SHAMIRA C
Entity Type:Individual
Prefix:
First Name:SHAMIRA
Middle Name:C
Last Name:NUNEZ GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4531 SW 2ND TER
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1506
Mailing Address - Country:US
Mailing Address - Phone:786-226-6426
Mailing Address - Fax:
Practice Address - Street 1:4531 SW 2ND TER
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1506
Practice Address - Country:US
Practice Address - Phone:786-226-6426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-325418106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician