Healthcare Provider Details

I. General information

NPI: 1720947583
Provider Name (Legal Business Name): SHELLY MARIA INFANTE UGALDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12205 SW 16TH TER APT A104
MIAMI FL
33175-1569
US

IV. Provider business mailing address

12205 SW 16TH TER APT A104
MIAMI FL
33175-1569
US

V. Phone/Fax

Practice location:
  • Phone: 786-930-5003
  • Fax:
Mailing address:
  • Phone: 305-903-0407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: