Provider Demographics
NPI:1407183189
Name:SHANER, AMY D (SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:D
Last Name:SHANER
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 1:10625 N MILITARY TRL
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6564
Mailing Address - Country:US
Mailing Address - Phone:561-691-1911
Mailing Address - Fax:561-691-4047
Practice Address - Street 1:10625 N MILITARY TRL
Practice Address - Street 2:SUITE 207
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6564
Practice Address - Country:US
Practice Address - Phone:561-691-1911
Practice Address - Fax:561-691-4047
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8590235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist