Provider Demographics
NPI:1124300413
Name:DE LA ROSA, SHIRLEY (OD)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:
Last Name:DE LA ROSA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7157 NARCOOSSEE RD # 1308
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-5533
Mailing Address - Country:US
Mailing Address - Phone:321-430-1266
Mailing Address - Fax:
Practice Address - Street 1:5020 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4312
Practice Address - Country:US
Practice Address - Phone:321-430-1266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002476152W00000X
390200000X
FLOPC5850152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program