Provider Demographics
NPI:1447430517
Name:SHUSTER, PAIGE LINDSAY (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:LINDSAY
Last Name:SHUSTER
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 1:805 DUVAL CT
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-2635
Mailing Address - Country:US
Mailing Address - Phone:727-418-9925
Mailing Address - Fax:727-559-1156
Practice Address - Street 1:805 DUVAL CT
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-2635
Practice Address - Country:US
Practice Address - Phone:727-418-9925
Practice Address - Fax:727-559-1156
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5630235Z00000X
FLSA 9686235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000563800Medicaid
FL001954200Medicaid
NC7211823Medicaid
FLCF744AOtherMEDICARE PTAN