Provider Demographics
NPI:1124847306
Name:MONTANEZ SANTOS, SHELYMAR
Entity type:Individual
Prefix:
First Name:SHELYMAR
Middle Name:
Last Name:MONTANEZ SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6-27 CALLE 5
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-6639
Mailing Address - Country:US
Mailing Address - Phone:939-475-6964
Mailing Address - Fax:
Practice Address - Street 1:2023 PASEO AZALEA
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4254
Practice Address - Country:US
Practice Address - Phone:939-475-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4880-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist