Provider Demographics
NPI:1811295728
Name:EBERE, SHANITA
Entity type:Individual
Prefix:
First Name:SHANITA
Middle Name:
Last Name:EBERE
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 1:43100 PALM ROYALE DR
Mailing Address - Street 2:APT 227
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-7991
Mailing Address - Country:US
Mailing Address - Phone:773-414-6292
Mailing Address - Fax:323-315-2383
Practice Address - Street 1:43100 PALM ROYALE DR
Practice Address - Street 2:APT 227
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-7991
Practice Address - Country:US
Practice Address - Phone:773-414-6292
Practice Address - Fax:323-315-2383
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009919235Z00000X
CA22166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist