Provider Demographics
NPI:1164987954
Name:SHELLARD, SARAH (CCC SLP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SHELLARD
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 1:38 SCHANCK AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-7124
Mailing Address - Country:US
Mailing Address - Phone:585-333-4770
Mailing Address - Fax:585-625-0107
Practice Address - Street 1:38 SCHANCK AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-7124
Practice Address - Country:US
Practice Address - Phone:585-333-4770
Practice Address - Fax:585-625-0107
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NY031000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist