Provider Demographics
NPI:1205384302
Name:GORING SHEALY, MONIQUE NICOLE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:NICOLE
Last Name:GORING SHEALY
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 1:1804 ANTLER CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-8587
Mailing Address - Country:US
Mailing Address - Phone:508-414-0124
Mailing Address - Fax:
Practice Address - Street 1:1804 ANTLER CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-8587
Practice Address - Country:US
Practice Address - Phone:508-414-0124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-17
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1704151235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist