MEDICARE: ERNIESHA MASON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1538529953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNIESHA MASON

Provider Business Mailing Address
First Line	:	8406 RED SPRUCE AVE
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-8994
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2051 WALDEN WOODS DR
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-3610
Country	:	US
Telephone Number	:	813-686-7617
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2016
Last Update Date	:	12/17/2025

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Directions to “ ERNIESHA MASON ” Practice Location

Language	Start Address	Practice Location

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