Provider Demographics
NPI:1235463670
Name:MCSHANE, RACHEL K (MS, CCC-SLP, TSLD)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:K
Last Name:MCSHANE
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 DICTUM CT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5910
Mailing Address - Country:US
Mailing Address - Phone:718-743-6343
Mailing Address - Fax:
Practice Address - Street 1:21 DICTUM CT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5910
Practice Address - Country:US
Practice Address - Phone:718-743-6343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist