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General NPI Number Information
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NPI Number | 1114488988
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Entity Type | Individual
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Provider Name | SHANTELL ELISS DEL PINO
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Gender | Female
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 01/26/2022
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Provider Practice Location Address
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Address Line | 3915 BISCAYNE BLVD FL 2
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City | MIAMI
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State | FL
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Zip | 33137-3779
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Country | US
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Telephone | 305-542-2589
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Fax |
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Provider Business Mailing Address
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Address Line | 1046 SW 180TH TER
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-4424
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Country | US
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Telephone | 305-542-2589
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 8575
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License Number State | FL
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