Healthcare Provider Details

I. General information

NPI: 1750180352
Provider Name (Legal Business Name): HAILEY SHINEGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22391 FLORA PARKE XING UNIT A
FERNANDINA BEACH FL
32034-8005
US

IV. Provider business mailing address

3085 SUNSET LANDING DR
JACKSONVILLE FL
32226-4445
US

V. Phone/Fax

Practice location:
  • Phone: 904-321-9054
  • Fax:
Mailing address:
  • Phone: 904-864-4687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI7807
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: