Provider Demographics
NPI:1033356332
Name:RHINESS-O'GARA, SHELLY JANELEE (MS/CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:JANELEE
Last Name:RHINESS-O'GARA
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 BLACK CORAL AVE NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-9493
Mailing Address - Country:US
Mailing Address - Phone:270-313-6500
Mailing Address - Fax:
Practice Address - Street 1:956 BLACK CORAL AVE NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-9493
Practice Address - Country:US
Practice Address - Phone:270-313-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 14249235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist