Provider Demographics
NPI:1144760406
Name:TEIXEIRA, SHAYLA (MS)
Entity Type:Individual
Prefix:MRS
First Name:SHAYLA
Middle Name:
Last Name:TEIXEIRA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SHAYLA
Other - Middle Name:
Other - Last Name:BONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, SLP
Mailing Address - Street 1:PO BOX 5725
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94955-5725
Mailing Address - Country:US
Mailing Address - Phone:479-220-0957
Mailing Address - Fax:707-238-1411
Practice Address - Street 1:1035 STAGE GULCH RD
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-9550
Practice Address - Country:US
Practice Address - Phone:479-220-0957
Practice Address - Fax:707-238-1411
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22776235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist