Healthcare Provider Details

I. General information

NPI: 1235595471
Provider Name (Legal Business Name): MARISSA SHERMAN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 06/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 SHERIDAN ST SUITE 209
HOLLYWOOD FL
33026-1505
US

IV. Provider business mailing address

11011 SHERIDAN ST SUITE 209
HOLLYWOOD FL
33026-1505
US

V. Phone/Fax

Practice location:
  • Phone: 954-431-5467
  • Fax: 954-431-0202
Mailing address:
  • Phone: 954-431-5437
  • Fax: 954-432-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA14654
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: