Provider Demographics
NPI:1215163951
Name:SHANKS, SARAH CATE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:CATE
Last Name:SHANKS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15475 SW 146TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-4632
Mailing Address - Country:US
Mailing Address - Phone:305-807-4882
Mailing Address - Fax:305-385-0182
Practice Address - Street 1:15475 SW 146TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-4632
Practice Address - Country:US
Practice Address - Phone:305-807-4882
Practice Address - Fax:305-385-0182
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7637235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889666600Medicaid