Provider Demographics
NPI:1740949395
Name:RAMOS-BURGOS, SHALIMAR (MA, S/T)
Entity type:Individual
Prefix:
First Name:SHALIMAR
Middle Name:
Last Name:RAMOS-BURGOS
Suffix:
Gender:F
Credentials:MA, S/T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 GA HIGHWAY 96 STE A
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2587
Mailing Address - Country:US
Mailing Address - Phone:229-815-3905
Mailing Address - Fax:
Practice Address - Street 1:940 GA HIGHWAY 96 STE A
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-2587
Practice Address - Country:US
Practice Address - Phone:229-815-3905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty