Basic Information
| Provider Information | |||||||||
| NPI: | 1164601803 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIVERA OCTTAVIANI | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 216 | ||||||||
| Address2: | |||||||||
| City: | MERCEDITA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007150216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878408284 | ||||||||
| FaxNumber: | 7878440225 | ||||||||
| Practice Location | |||||||||
| Address1: | 2213 PONCE BY PASS | ||||||||
| Address2: | |||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878408686 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2007 | ||||||||
| LastUpdateDate: | 05/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 754 | PR | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.