Provider Demographics
NPI:1356815450
Name:SEAY, SHANKESHA (BS, ASST-SLP)
Entity Type:Individual
Prefix:
First Name:SHANKESHA
Middle Name:
Last Name:SEAY
Suffix:
Gender:F
Credentials:BS, ASST-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N HENDERSON AVE APT 217
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-5071
Mailing Address - Country:US
Mailing Address - Phone:318-499-1077
Mailing Address - Fax:
Practice Address - Street 1:1231 GREENWAY DR STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2525
Practice Address - Country:US
Practice Address - Phone:972-871-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX401742355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX40174Medicaid