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General NPI Number Information
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NPI Number | 1710496237
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Entity Type | Organization
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Legal Business Name | SHEDEV COMMUNITY OUTREACH CENTER, INC
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Dates
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Enumeration Date | 09/27/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 11812 GILMERTON DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-3929
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Country | US
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Telephone | 718-637-1556
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Fax |
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Provider Business Mailing Address
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Address Line | 13194 US HIGHWAY 301 S STE 147
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City | RIVERVIEW
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State | FL
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Zip | 33578-7410
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Country | US
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Telephone | 813-677-8106
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHERON ALEXIS-JOHN
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Credential |
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Telephone | 718-637-1556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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