Healthcare Provider Details

I. General information

NPI: 1629745302
Provider Name (Legal Business Name): SHALIA L MOORE-HAYES PSY. S, NASP, ED D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 6TH ST W
PALMETTO FL
34221-5136
US

IV. Provider business mailing address

10205 36TH CT E
PARRISH FL
34219-2023
US

V. Phone/Fax

Practice location:
  • Phone: 941-845-4535
  • Fax:
Mailing address:
  • Phone: 941-845-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1886
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: