Provider Demographics
NPI:1093241820
Name:SHUB, MELISSA B (SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:B
Last Name:SHUB
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:B
Other - Last Name:RUBIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:11660 ALPHARETTA HWY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4943
Mailing Address - Country:US
Mailing Address - Phone:770-754-0085
Mailing Address - Fax:770-754-9288
Practice Address - Street 1:11660 ALPHARETTA HWY
Practice Address - Street 2:SUITE 320
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4943
Practice Address - Country:US
Practice Address - Phone:770-754-0085
Practice Address - Fax:770-754-9288
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009639235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist