Provider Demographics
NPI:1235875238
Name:ESTRADA, SHAY L (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHAY
Middle Name:L
Last Name:ESTRADA
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 1:25936 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-5549
Mailing Address - Country:US
Mailing Address - Phone:951-634-2234
Mailing Address - Fax:
Practice Address - Street 1:400 W WHITTIER AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-5940
Practice Address - Country:US
Practice Address - Phone:951-765-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9189235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist