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General NPI Number Information
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NPI Number | 1306671581
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Entity Type | Individual
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Provider Name | MARYEM ALI SHIHA BA, SLPA
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Gender | Female
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Dates
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Enumeration Date | 09/05/2024
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 2006 W OAK AVE
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City | PLANT CITY
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State | FL
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Zip | 33563-7255
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Country | US
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Telephone | 813-757-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 14059 RIVEREDGE DR UNIT 3101
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City | TAMPA
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State | FL
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Zip | 33637-1059
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Country | US
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Telephone | 352-207-5967
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number |
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License Number State |
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