Provider Demographics
NPI:1194408740
Name:SHUB, JENNIFER KATE (PSYD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KATE
Last Name:SHUB
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 MADRUGA AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3048
Mailing Address - Country:US
Mailing Address - Phone:786-606-0302
Mailing Address - Fax:
Practice Address - Street 1:1550 MADRUGA AVE STE 510
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3048
Practice Address - Country:US
Practice Address - Phone:786-606-0302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty