Provider Demographics
NPI:1083127195
Name:ROY, SHELBY SEDONA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:SEDONA
Last Name:ROY
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 1:1715 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-5025
Mailing Address - Country:US
Mailing Address - Phone:602-680-0350
Mailing Address - Fax:
Practice Address - Street 1:NORTHLAND-RURAL THERAPY ASSOCIATES
Practice Address - Street 2:2915 NORTH 4TH STREET
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004
Practice Address - Country:US
Practice Address - Phone:928-779-1679
Practice Address - Fax:928-779-2822
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-10
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP10924235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist