Healthcare Provider Details

I. General information

NPI: 1306671581
Provider Name (Legal Business Name): MARYEM ALI SHIHA BA, SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 W OAK AVE
PLANT CITY FL
33563-7255
US

IV. Provider business mailing address

14059 RIVEREDGE DR UNIT 3101
TAMPA FL
33637-1059
US

V. Phone/Fax

Practice location:
  • Phone: 813-757-9300
  • Fax:
Mailing address:
  • Phone: 352-207-5967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: