Provider Demographics
NPI:1417233875
Name:OLIVER, SHELLEY ROBINSON (MS/CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:ROBINSON
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1994 FIVE MILE LINE RD
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1054
Mailing Address - Country:US
Mailing Address - Phone:315-524-1000
Mailing Address - Fax:315-524-1169
Practice Address - Street 1:1994 FIVE MILE LINE RD
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1054
Practice Address - Country:US
Practice Address - Phone:315-524-1000
Practice Address - Fax:315-524-1169
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005609235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist