Provider Demographics
NPI:1285181024
Name:TORRES, SHANNON (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:TORRES
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 1:55 TEPLITZ CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-1853
Mailing Address - Country:US
Mailing Address - Phone:845-361-7026
Mailing Address - Fax:
Practice Address - Street 1:55 TEPLITZ CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-1853
Practice Address - Country:US
Practice Address - Phone:845-361-7026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011264-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist