Healthcare Provider Details

I. General information

NPI: 1790612042
Provider Name (Legal Business Name): SHELLY'S SOULFUL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 PALMETTO FRNTG RD STE 104A
MIAMI LAKES FL
33016-1568
US

IV. Provider business mailing address

14100 PALMETTO FRNTG RD STE 104A
MIAMI LAKES FL
33016-1568
US

V. Phone/Fax

Practice location:
  • Phone: 305-903-0407
  • Fax:
Mailing address:
  • Phone: 305-903-0407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHELLY MARIA INFANTE UGALDE
Title or Position: PRESIDENT
Credential:
Phone: 305-903-0407