Provider Demographics
NPI:1215215108
Name:SHEHADEH, ERICA C
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:C
Last Name:SHEHADEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HORNET DR
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-2732
Mailing Address - Country:US
Mailing Address - Phone:573-590-8000
Mailing Address - Fax:576-590-8090
Practice Address - Street 1:2 HORNET DR
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-2732
Practice Address - Country:US
Practice Address - Phone:573-590-8000
Practice Address - Fax:576-590-8090
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011018663235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1346313814Medicaid