Provider Demographics
NPI:1003149196
Name:LOPEZ, SHAREN MICHELLE (MS CCC-SLP/TSHH)
Entity Type:Individual
Prefix:MRS
First Name:SHAREN
Middle Name:MICHELLE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS CCC-SLP/TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5721 GRANGER ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3931
Mailing Address - Country:US
Mailing Address - Phone:917-887-4948
Mailing Address - Fax:
Practice Address - Street 1:5721 GRANGER ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3931
Practice Address - Country:US
Practice Address - Phone:917-887-4948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017312235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist