Healthcare Provider Details

I. General information

NPI: 1851579544
Provider Name (Legal Business Name): SHENIKA LATOYA ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4307 COLONY WAY
ORLANDO FL
32808-6405
US

IV. Provider business mailing address

4307 COLONY WAY
ORLANDO FL
32808-6405
US

V. Phone/Fax

Practice location:
  • Phone: 850-321-9315
  • Fax:
Mailing address:
  • Phone: 850-321-9315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: