Provider Demographics
NPI:1427554286
Name:DORNBACK, SHIRLEY DALETTE (AUD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:DALETTE
Last Name:DORNBACK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 SONATA LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2239
Mailing Address - Country:US
Mailing Address - Phone:469-877-8727
Mailing Address - Fax:
Practice Address - Street 1:2116 SONATA LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2239
Practice Address - Country:US
Practice Address - Phone:469-877-8727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51097231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist