Provider Demographics
NPI:1770116188
Name:ASHRAF, SHANA
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:ASHRAF
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 1:1401 FORUM WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2324
Mailing Address - Country:US
Mailing Address - Phone:561-689-2147
Mailing Address - Fax:561-214-4962
Practice Address - Street 1:1401 FORUM WAY STE 300
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2324
Practice Address - Country:US
Practice Address - Phone:561-689-2147
Practice Address - Fax:561-214-4962
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist