Provider Demographics
NPI:1073635439
Name:SHAY, MICHELE NICOLE (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:NICOLE
Last Name:SHAY
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3986 TRENTON TRL
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-1729
Mailing Address - Country:US
Mailing Address - Phone:330-273-7339
Mailing Address - Fax:
Practice Address - Street 1:18840 FALLING WATER RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-4200
Practice Address - Country:US
Practice Address - Phone:440-238-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5777235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist