Provider Demographics
NPI:1356577563
Name:LOPEZ ACEVEDO, SHAIRA J (SPEECH LANGUAGE PATH)
Entity type:Individual
Prefix:MS
First Name:SHAIRA
Middle Name:J
Last Name:LOPEZ ACEVEDO
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VILLA GRILLASCA 906 VIRGILIO BIAGGI
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717
Mailing Address - Country:US
Mailing Address - Phone:787-840-7928
Mailing Address - Fax:787-290-2475
Practice Address - Street 1:URB. VILLA GRILLASCA 906 VIRGILIO BIAGGI
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-840-7928
Practice Address - Fax:787-290-2475
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR803235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist