Provider Demographics
NPI:1205574969
Name:AVILA LOPEZ, SHAKIRA
Entity type:Individual
Prefix:
First Name:SHAKIRA
Middle Name:
Last Name:AVILA LOPEZ
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 1:16140 NW 83RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6689
Mailing Address - Country:US
Mailing Address - Phone:305-834-5050
Mailing Address - Fax:
Practice Address - Street 1:16140 NW 83RD PL
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-6689
Practice Address - Country:US
Practice Address - Phone:305-834-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty