Healthcare Provider Details

I. General information

NPI: 1932559291
Provider Name (Legal Business Name): SHAILA PEREZ I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E LAKE HOWARD DR
WINTER HAVEN FL
33881-3155
US

IV. Provider business mailing address

160 E LAKE HOWARD DR
WINTER HAVEN FL
33881-3155
US

V. Phone/Fax

Practice location:
  • Phone: 863-299-1251
  • Fax: 863-299-3728
Mailing address:
  • Phone: 863-299-1251
  • Fax: 863-299-3728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY2028
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: