Provider Demographics
NPI:1508064486
Name:ROQUE RODRIGUEZ, SHAMIR I (SLP)
Entity type:Individual
Prefix:MRS
First Name:SHAMIR
Middle Name:I
Last Name:ROQUE RODRIGUEZ
Suffix:
Gender:
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-1554
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE DOCTOR GOYCO ESQUINA
Practice Address - Street 2:ACOSTA LOCAL 202
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-9998
Practice Address - Country:US
Practice Address - Phone:787-638-5386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4384235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1373-2OtherTERAPISTA DEL HABLA