Provider Demographics
NPI:1407262132
Name:SHAH, SHANA (SPEECH AND LANGUAGE)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:SPEECH AND LANGUAGE
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:
Other - Last Name:FOGARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1020 NORTH KINGS HIGHWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034
Mailing Address - Country:US
Mailing Address - Phone:856-602-4000
Mailing Address - Fax:856-842-5109
Practice Address - Street 1:200 BOWMAN DRIVE
Practice Address - Street 2:SUITE D285
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-602-4000
Practice Address - Fax:856-946-1747
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011354174400000X
NJ41YS500571200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174400000XOther Service ProvidersSpecialist