MEDICARE: SHIFRA SHARFMAN M.A. CCC SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA4233	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S2175	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1710019716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIFRA SHARFMAN M.A. CCC SLP

Provider Business Mailing Address
First Line	:	1210 NE 173RD ST
Second Line	:
City	:	N MIAMI BEACH
State	:	FL
Zip	:	33162-1233
Country	:	US
Telephone Number	:	305-690-9185
Fax Number	:	305-690-9185

Provider Business Practice Location Address
First Line	:	1210 NE 173RD ST
Second Line	:
City	:	N MIAMI BEACH
State	:	FL
Zip	:	33162-1233
Country	:	US
Telephone Number	:	305-690-9185
Fax Number	:	305-690-9185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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