Provider Demographics
NPI:1104008176
Name:ROCHE, SHELLI ANN (MA, CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:SHELLI
Middle Name:ANN
Last Name:ROCHE
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 BRANT RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-1802
Mailing Address - Country:US
Mailing Address - Phone:401-447-8183
Mailing Address - Fax:
Practice Address - Street 1:52 BRIGHAM ST
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2210
Practice Address - Country:US
Practice Address - Phone:508-991-2332
Practice Address - Fax:508-991-8437
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00450235Z00000X
MA3465235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist