Provider Demographics
NPI:1316519770
Name:HERNANDEZ, SHARON REBECA I
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:REBECA
Last Name:HERNANDEZ
Suffix:I
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 1:6831 SW 147TH AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1003
Mailing Address - Country:US
Mailing Address - Phone:305-305-7054
Mailing Address - Fax:
Practice Address - Street 1:12966 SW 89TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-5850
Practice Address - Country:US
Practice Address - Phone:786-554-8920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA20644235Z00000X
FLSI48802355S0801X
FLSZ10371235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant