Provider Demographics
NPI:1164595211
Name:AHERN, MELISSA SHUSTER (MS, CCC-SLP, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:SHUSTER
Last Name:AHERN
Suffix:
Gender:F
Credentials:MS, CCC-SLP, OTR/L
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:P
Other - Last Name:SHUSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 SAWTOOTH LN
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-2053
Mailing Address - Country:US
Mailing Address - Phone:267-254-1337
Mailing Address - Fax:
Practice Address - Street 1:1515 THE FAIRWAY
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-1435
Practice Address - Country:US
Practice Address - Phone:267-254-1337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006915L225XP0200X
PASL009156235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019365350002Medicaid