Provider Demographics
NPI:1417164260
Name:BISHOP, SHELLEY M (BS SLPA)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:M
Last Name:BISHOP
Suffix:
Gender:F
Credentials:BS SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 BAY RD
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-9772
Mailing Address - Country:US
Mailing Address - Phone:413-695-4377
Mailing Address - Fax:
Practice Address - Street 1:2645 SW 37TH AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2754
Practice Address - Country:US
Practice Address - Phone:305-448-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI 13612355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant