Provider Demographics
NPI:1336981687
Name:SHUPING, LARA
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:SHUPING
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 1:789 W OAKLAND AVE APT 1412
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34787-1875
Mailing Address - Country:US
Mailing Address - Phone:863-991-3330
Mailing Address - Fax:
Practice Address - Street 1:6965 PIAZZA GRANDE AVE STE 208
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-8780
Practice Address - Country:US
Practice Address - Phone:321-437-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-08
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist