Provider Demographics
NPI:1417259151
Name:SHTARR, LUBA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LUBA
Middle Name:
Last Name:SHTARR
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 1:8 FOX HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1108
Mailing Address - Country:US
Mailing Address - Phone:646-573-5901
Mailing Address - Fax:
Practice Address - Street 1:8 FOX HOLLOW RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1108
Practice Address - Country:US
Practice Address - Phone:646-573-5901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00761200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist