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NPI Code Detail

MEDICARE: SHANNON DIMINO SA5877

MEDICARE: SHANNON DIMINO SA5877
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
1235Z00000XSpeech-Language PathologistSA5877FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780750943
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON DIMINO SA5877
Provider Business Mailing Address
First Line : 1225 MARTIN BLVD
Second Line :
City : ORLANDO
State : FL
Zip : 32825-6126
Country : US
Telephone Number : 407-306-8058
Fax Number :
Provider Business Practice Location Address
First Line : 12702 SCIENCE DR
Second Line :
City : ORLANDO
State : FL
Zip : 32826-3016
Country : US
Telephone Number : 407-281-0441
Fax Number : 407-281-0422
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2006
Last Update Date : 01/21/2011

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Directions to “ SHANNON DIMINO SA5877” Practice Location

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