Provider Demographics
NPI:1306671581
Name:SHIHA, MARYEM ALI (BA, SLPA)
Entity type:Individual
Prefix:
First Name:MARYEM
Middle Name:ALI
Last Name:SHIHA
Suffix:
Gender:F
Credentials:BA, SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14059 RIVEREDGE DR UNIT 3101
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-1059
Mailing Address - Country:US
Mailing Address - Phone:352-207-5967
Mailing Address - Fax:
Practice Address - Street 1:2006 W OAK AVE
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-7255
Practice Address - Country:US
Practice Address - Phone:813-757-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant