Healthcare Provider Details

I. General information

NPI: 1932640505
Provider Name (Legal Business Name): SHERLIE MEJIA SPL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B1 CALLE GLADIOLA CIUDAD JARDIN B1
CAROLINA PR
00987-2200
US

IV. Provider business mailing address

1B CALLE GLADIOLA CIUDAD JARDIN DE CAROLINA
CAROLINA PR
00987
US

V. Phone/Fax

Practice location:
  • Phone: 787-378-3200
  • Fax:
Mailing address:
  • Phone: 787-378-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1019
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: