Provider Demographics
NPI:1285093583
Name:SHADOFF, DEBRA
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:SHADOFF
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 1:2324 S CONGRESS AVE
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7669
Mailing Address - Country:US
Mailing Address - Phone:561-366-7219
Mailing Address - Fax:561-366-7250
Practice Address - Street 1:2324 S CONGRESS AVE
Practice Address - Street 2:SUITE 2G
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-7669
Practice Address - Country:US
Practice Address - Phone:561-366-7219
Practice Address - Fax:561-366-7250
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY787231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist