Provider Demographics
NPI:1275868515
Name:MARSH, SHELLEY (SLP)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:MARSH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 SOLANO CAY CIR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2239
Mailing Address - Country:US
Mailing Address - Phone:904-280-0338
Mailing Address - Fax:904-280-0338
Practice Address - Street 1:178 SOLANO CAY CIR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-2239
Practice Address - Country:US
Practice Address - Phone:904-280-0338
Practice Address - Fax:904-280-0338
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8973235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist