Healthcare Provider Details

I. General information

NPI: 1376352955
Provider Name (Legal Business Name): SHAKIRA COLON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/07/2025
Certification Date: 01/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. VALLES DE CERRO GORDO CALLE ZAFIRO AB-10
BAYAMON PR
00957
US

IV. Provider business mailing address

PO BOX 3413
BAYAMON PR
00958-0413
US

V. Phone/Fax

Practice location:
  • Phone: 787-640-2022
  • Fax:
Mailing address:
  • Phone: 787-640-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number8131
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: