Provider Demographics
NPI:1093279408
Name:SHAHA, MELANIE LYNN MANISH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:LYNN MANISH
Last Name:SHAHA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SAINT VINCENTS DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1620
Mailing Address - Country:US
Mailing Address - Phone:205-933-9236
Mailing Address - Fax:
Practice Address - Street 1:800 SAINT VINCENTS DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1620
Practice Address - Country:US
Practice Address - Phone:205-933-9236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4942235Z00000X
LA7752235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14180108OtherAMERICAN SPEECH AND HEARING ASSOCIATION