Provider Demographics
NPI:1891181889
Name:SHALE, MATTHEW (MA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:SHALE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 W MCNAB RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-5332
Mailing Address - Country:US
Mailing Address - Phone:954-657-8342
Mailing Address - Fax:954-657-8516
Practice Address - Street 1:7310 W MCNAB RD
Practice Address - Street 2:SUITE 107
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-5332
Practice Address - Country:US
Practice Address - Phone:954-657-8342
Practice Address - Fax:954-657-8516
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62042225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist