Provider Demographics
NPI:1588713051
Name:SHENOI, CHRISTINE MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:SHENOI
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:MARIE
Other - Last Name:KEELER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSCCC-SLP
Mailing Address - Street 1:17279 OLD TOBACCO RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-4947
Mailing Address - Country:US
Mailing Address - Phone:117-274-2224
Mailing Address - Fax:
Practice Address - Street 1:17279 OLD TOBACCO RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-4947
Practice Address - Country:US
Practice Address - Phone:727-422-2438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12104763235Z00000X
FLSA 8031235Z00000X
IL146008913235Z00000X
FLSA15082235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889419100Medicaid