Provider Demographics
NPI:1164067377
Name:PRIEST, TANYA SHAMY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:SHAMY
Last Name:PRIEST
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 1:660 HOLLOWAY MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-6326
Mailing Address - Country:US
Mailing Address - Phone:541-217-8338
Mailing Address - Fax:
Practice Address - Street 1:1260 HIDDEN COVE LN
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-4742
Practice Address - Country:US
Practice Address - Phone:828-394-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist