Provider Demographics
NPI:1932414687
Name:SHORES, TANYA LEE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:LEE
Last Name:SHORES
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 KERSFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:HEATHROW
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1933
Mailing Address - Country:US
Mailing Address - Phone:407-549-3964
Mailing Address - Fax:
Practice Address - Street 1:415 E PINE ST
Practice Address - Street 2:STE #1508
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2838
Practice Address - Country:US
Practice Address - Phone:407-808-8063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10604235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist