Provider Demographics
NPI:1922387778
Name:REID SANTANA, SHELITA LEBRINA (MED, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SHELITA
Middle Name:LEBRINA
Last Name:REID SANTANA
Suffix:
Gender:F
Credentials:MED, CCC-SLP
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Other - First Name:
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Mailing Address - Street 1:1211A IRELAND DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3372
Mailing Address - Country:US
Mailing Address - Phone:910-912-2201
Mailing Address - Fax:910-486-1590
Practice Address - Street 1:1211A IRELAND DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3372
Practice Address - Country:US
Practice Address - Phone:910-912-2201
Practice Address - Fax:910-486-1590
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC8982235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8982OtherSTATE OF NORTH CAROLINA BOARD OF EXAMINERS FOR SPEECH AND LANGUAGE PATHOLOGISTS