Provider Demographics
NPI:1417371410
Name:SHAVER, AMY (MA CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:SHAVER
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-2017
Mailing Address - Country:US
Mailing Address - Phone:203-589-5100
Mailing Address - Fax:
Practice Address - Street 1:84 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-2017
Practice Address - Country:US
Practice Address - Phone:203-589-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003621235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist