Basic Information
| Provider Information | |||||||||
| NPI: | 1205226347 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROMAN | ||||||||
| FirstName: | SHIRLEY | ||||||||
| MiddleName: | IVETTE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 827 SPRING PARK LOOP | ||||||||
| Address2: | |||||||||
| City: | CELEBRATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347474801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874121708 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | AVE PONCE DE LEON | ||||||||
| Address2: | HOSPITAL AUXILIO MUTUO | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009073907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877582000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2015 | ||||||||
| LastUpdateDate: | 01/28/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 13509-I | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.