Provider Demographics
NPI:1992903785
Name:SHIRO, EDITH (PSYD)
Entity type:Individual
Prefix:DR
First Name:EDITH
Middle Name:
Last Name:SHIRO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21200 NE 38TH AVENUE
Mailing Address - Street 2:APT #1402
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180
Mailing Address - Country:US
Mailing Address - Phone:305-936-0792
Mailing Address - Fax:
Practice Address - Street 1:350 NW 70TH AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317
Practice Address - Country:US
Practice Address - Phone:954-587-7520
Practice Address - Fax:954-587-7527
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7787103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical