Provider Demographics
NPI:1750180352
Name:SHINEGO, HAILEY
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:SHINEGO
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 1:3085 SUNSET LANDING DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-4445
Mailing Address - Country:US
Mailing Address - Phone:904-864-4687
Mailing Address - Fax:
Practice Address - Street 1:22391 FLORA PARKE XING UNIT A
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-8005
Practice Address - Country:US
Practice Address - Phone:904-321-9054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI78072355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant