Provider Demographics
NPI:1932228640
Name:DE LA ROSA, SHELLIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHELLIE
Middle Name:
Last Name:DE LA ROSA
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6513 SPRING MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-3473
Mailing Address - Country:US
Mailing Address - Phone:321-217-2389
Mailing Address - Fax:561-623-0051
Practice Address - Street 1:6513 SPRING MEADOW DR
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33413-3473
Practice Address - Country:US
Practice Address - Phone:321-217-2389
Practice Address - Fax:561-623-0051
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8891235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL892230000Medicaid