Provider Demographics
NPI:1902496847
Name:NEGRON, SHAHIRA
Entity Type:Individual
Prefix:
First Name:SHAHIRA
Middle Name:
Last Name:NEGRON
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 1:3200 OLD WINTER GARDEN RD APT 2432
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4543
Mailing Address - Country:US
Mailing Address - Phone:787-530-9193
Mailing Address - Fax:
Practice Address - Street 1:3200 OLD WINTER GARDEN RD APT 2432
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4543
Practice Address - Country:US
Practice Address - Phone:787-530-9193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health